Frequently Asked Questions
What is the NDC requirement when billing HCPCS drug claims?
Claims containing physician administered drugs are still being submitted without the required National Drug Code (NDC). Medicaid requires the NDC for all HCPCS codes beginning with “J” and some “A, Q, K and S” codes (Code list is available at http://health.utah.gov/medicaid/pdfs/NDC ).Medicaid currently edits if the NDC submitted is valid. The NDC must be entered with 11 digits in a 5-4-2 digit format. The first five digits of the NDC are the manufacturer’s labeler code, the middle four digits are the product code, and the last two digits are the package size. If you are given an NDC that is less than 11 digits, add the missing digits as follows:
- For a 4-4-2 digit number, add a 0 to the beginning.
- For a 5-3-2 digit number, add a 0 as the sixth digit.
- For a 5-4-1 digit number, add a 0 as the tenth digit.