NDC code report formating CMS 1500 and electronic claim

NDC Reporting Guidelines

An NDC is required for pharmaceuticals that are dispensed from a pharmacy and physician-administered drugs in an office/clinic (i.e. FQHC/RHCs, dialysis facilities) or outpatient facility/hospital setting.

* Provider must submit the 11-digit National Drug Code (NDC), found on the vial of medication, associated with the administered drug.

* NDC codes should be reported according to the format set out by the National Drug Code Directory.

* NDC codes contain 3 segments each with a set number of characters.

* NDC codes MUST be billed with the N4 qualifier before the 11 digit NDC code, when billing on a paper claim

* N4 qualifier also applies to EDI claims. Include on EDI claim, open the loop for NDC in the Practice Management System and enter the 11 digit NDC code. The system will electronically insert the N4 qualifier in the correct location upon activating the loop.

Seg 1      Seg 2    Seg3
5 Digits 4 Digits 2 Digits
Labeler Product Size

NOTE: Segments are to run together with no spaces, dashes, or hyphens

Segment 1= Labeler Code; this segment will contain a 5 digit labeler code. Code should be preceded by 0’s (zeros) if the code does not equal 5 digits.

Example: Labeler Code is 56 then the segment entry would be 00056. (Padded with 3 zeros to complete the 5 digit label code)

Segment 2= Product Code; this segment will contain a 4 digit product code. The product code will always be 4 digits and will not require padding with zeros.

Segment 3= Trade Package Size; this segment will contain a 2 digit size code. The trade package size code will always be 2 digits and will not require padding with zeros.

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