The Deficit Reduction Act (DRA) mandates that all physician-administered drug claims require a National Drug Code (NDC). To comply with the DRA, providers must bill for these drugs using the appropriate CPT-4, HCPCS Level II, or local HCPCS Level III codes and, in addition, must include the NDC on the claim form. Providers have been encouraged, for dates of service on or after September 1, 2008, to include the NDC code on the claim.

An analysis of providers’ claim submissions for dates of service on or after September 1, 2008 indicates that physician-administered drug claims are being submitted without the NDC. Such claims are currently reimbursable, but providers are reminded that claims with dates of service on or after April 1, 2009 that do not meet the NDC reporting requirements by including a valid NDC with a HCPCS code will be denied.

Note:

HCPCS codes X1500 and Z7610 used by the Family PACT (Planning, Access, Care and Treatment) Program do not require an NDC.

Resources
For more information on NDC reporting, including FAQs, please visit the NDC Overview page. The full policy article published in recent Medi-Cal Updates can be viewed.

Note:

For dates of service on or after April 1, 2009, only those products manufactured by companies participating in the federal Medicaid rebate program will be reimbursable under Medi-Cal.

A list of manufacturers participating in the rebate program, which changes periodically, is available in the Drugs: Contract Drugs List Part 5 – Authorized Manufacturer Labeler Codes section of the Medi-Cal Part 2 manual.

The ASC X12N Version 4010A1 Companion Guides have been updated and are available on the Medi-Cal Web site.

Additionally, the September 2008 Part 2 provider bulletins included NDC information, physician-administered drug definitions, billing descriptions and examples for CMS-1500 and UB-04 paper claim forms, as well as both 837 Institutional and Professional electronic formats and Section 340B information. These bulletins can be viewed on the Medi-Cal Web site. Finally, the CMS-1500 and UB-04 claim form tutorials have been updated and can be viewed on the eLearning page.

Provider Training
Training workshops were scheduled in January and February 2009 to address the NDC billing requirements and the information will be included in the Medi-Cal seminars in Burlingame and Long Beach. Seminar registration is now available online. The dates, times, locations and registration information for the seminars can be found on the Training Seminars page.

For those who cannot attend the workshops, PDF versions of the PowerPoint presentations were posted in the “What’s New” area of the NDC Overview page.

Should providers have any questions or need additional information, please call the Telephone Service Center (TSC) at 1-800-541-5555 and choose the appropriate prompt.