- What is the National Drug Code (NDC)?
A: The NDC is a number that identifies a prescription drug. The NDC number consists of 11 digits in 5-4-2 format.
- What is a physician-administered drug?
A: A physician-administered drug includes any covered outpatient drug provided or administered to a recipient that is billed by a provider other than a pharmacy. These providers would include, but not be limited to, physician offices, clinics and hospitals.
- When do we need to start sending NDCs on claims to Medi-Cal?
A: Effective for dates of service from September 1, 2008 through March 31, 2009, providers are encouraged to begin using the NDC in conjunction with the customary Healthcare Common Procedure Coding System (HCPCS) Level I, II or III code. Claims for those dates of service that do not include an NDC will not be denied.
- What claim submission methods can providers use?
A: Providers may submit paper claims using the CMS-1500 and UB-04 claim forms, or electronic claims via 837 Institutional and Professional formats. The Point of Service (POS) device and Internet Professional Claim Submission (IPCS) system have not been updated. Providers using those means of claims submission must continue to provide the HCPCS code only.
- Is there a future implementation date?
A: Yes. Claims with dates of service on or after April 1, 2009 that do not meet the NDC reporting requirements of a valid NDC present with a HCPCS code will result in that claim being denied.
- Are there any examples or billing instructions available?
A: An article announcing the updated companion guides for electronic transactions will be available on the Medi-Cal Web site. Manual replacement pages will be updated in September 2008.
- Additional Resources
A: Providers may refer to future Medi-Cal Updates or contact the Telephone Service Center (TSC) at 1-800-541-5555 for more information.
