National Drug Code (NDC) Frequently Asked Questions
1. Question: The Acute Care 837(Professional) Electronic Companion Guide as well
as the published instructions for the UB-04, CMS-1500 and FP2017 claim forms
provide that submitted National Drug Codes (NDCs) “must contain a valid 11
numeric NDC in the 5-4-2 format.” The package or container, however, contains
an NDC with 10-digits. I’m also not sure whether I should report the NDC with
or without dashes. What should I do?
Answer: Proper billing of claims submitted for a physician-administered HCPCS
drug code listed on the Palmetto GBA HCPCS-to-NDC crosswalk requires an 11digit, all numeric NDC. You should first determine what format your 10-digit
NDC is in by examining the package information and counting the numbers
separated by the dashes. Once you have identified the format as either 4-4-2, 53-2 or 5-4-1, insert a 0 according to the following table:
10-digit NDC to 11-digit NDC
10-digit format:
Then add a zero (0) in:
st
4-4-2 *########-##
1 position 0####-####-##
5-3-2 #####*###-##
6 position #####-0###-##
5-4-1 #########-*#
10 position #####-####-0#
th
th
Report NDC as:
0##########
#####0#####
#########0#
Please note that the NDC submitted must not contain any space, hyphen, or other
separator.
2. Question: I am attempting to bill for a HCPCS code contained on the latest
Palmetto GBA HCPCS-to-NDC crosswalk, but the crosswalk does not list the
NDC number on the drug’s packaging. Is Texas Medicaid & Healthcare
Partnership (TMHP) addressing this situation?
Answer: The Palmetto crosswalk list of NDCs for each HCPCS code is not all
inclusive. It is the responsibility of the provider to identify and bill the most
appropriate HCPCS/NDC combination. TMHP is in the process of
supplementing the Palmetto HCPCS-to-NDC crosswalk to include all NDC
values for each of the procedure codes listed. Providers should monitor tmhp.com
for NDC related information.
3. Question: The Palmetto GBA HCPCS-to-NDC crosswalk lists the NDC that I
have submitted as valid for the procedure code that I am billing for. My claim,
however, has denied with the following explanation: “THE SUBMITTED NDC
DOESN'T CORRESPOND WITH THE DRUG CODE, MODIFIER OR DATES
ON THE NDC CROSSWALK
Answer: Please ensure that the NDC that you submitted is taken from the drug’s
packaging and is valid for the claim’s date of service. If you are viewing the
Palmetto crosswalk, then you can verify this by checking to see that the date of
service is between the dates listed as the “Relationship Start Date (Column E)”
and the “Relationship End Date (Column F)” for the specific HCPCS/NDC
combination.