The Federal Deficit Reduction Act of 2005 (DRA) requires all state Medicaid agencies to collect rebates from drug manufacturers for physician-administered drugs. The collection of rebates will be accomplished with the inclusion of National Drug Codes (NDCs) on claims submitted by providers.

Beginning September 1, 2008, providers are encouraged to begin using NDC for physician-administered drugs in conjunction with the customary Healthcare Common Procedure Coding System (HCPCS) Level I, II or III code, on all Medi-Cal claims. Medi-Cal will continue to process reimbursements according to the HCPCS codes and quantities. For more information, refer to the NDC Required for Physician-Administered Drugs Effective April 1, 2009 article.

Physician-administered drugs include any covered outpatient drug billed by a provider other than a pharmacy. This includes (but is not limited to) the following provider types:

  • Physicians
  • Clinics
  • Hospitals

The new NDC reporting requirement will apply to claims submitted using the following formats:

  • 837 electronic transactions for Institutional and Professional claims
  • CMS-1500 and UB-04 paper claims
  • Internet Professional Claims Submission (IPCS) system

Submission of the appropriate NDC is encouraged beginning September 1, 2008;  however, applicable claims with dates of service on or after April 1, 2009 must include the appropriate NDCs in order to be reimbursed.

For additional information regarding NDCs on claims, contact the Telephone Service Center (TSC) at 1-800-541-5555, select language preference (option 11 for English; option 12 for Spanish) and then select the appropriate option based on claim type. Providers can also review the eLearning tutorials page for specific information about using NDCs on the CMS-1500 and UB-04 claims forms.

Frequently Asked Questions