© 2019 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Printed Date: 9/22/2015
When billing for services using the unclassified drug codes or not otherwise classified (NOC) drug codes, it is important to submit only the required documentation. Palmetto GBA will not be requesting any documentation so it is important to include the documentation listed under 'Required Documentation'. By submitting additional information beyond what is required or submitting conflicting information could cause the service to be rejected.
The required narrative documentation is to be entered in the appropriate comment/narrative field (Loop 2400 - SV101-7) for that detail line. For paper claims, the documentation should be entered in Block 19.
Quantity Billed/Number of Services
Providers should enter ‘1’ in the quantity billed/number of services field and enter the total amount of the drug or biological actually administered (in mg or mcg) in block 19 or the electronic equivalent field.
If any of the required documentation is missing, incomplete or invalid, the service(s) will be rejected. Palmetto GBA will not be requesting the documentation.
Drugs Requiring Invoices/Supporting Documentation
Please refer to the ‘Submitting Additional Documentation’ article found on Palmetto’s website.
Drugs Requiring only Comment in Narrative/Block 19
Besides the required documentation (name, dosage and NDC), some drugs may require additional comments in the narrative. These situations would be addressed in an article for the specific drug on CMS Medicare Coverage Database (MCD). For other references of required information, refer the FDA Website.
Any required narrative documentation is to be entered in the appropriate comment/narrative field (Loop 2400 - SV101-7) for that detail line. For paper claims, the documentation should be entered in Block 19.
In order to avoid rejections, resubmissions, etc., please ensure when submitting the required documentation to only submit what is required and be sure the information is not conflicting. This is especially important when it comes to the dosage being submitted.
Palmetto GBA will not be requesting any documentation. It is important to correctly submit the drug name, total dosage (this is amount actually administered) and the NDC number noted under the “Required Documentation” section in this article.
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question
This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 04/02/2018