Professional Documents
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NDC Faqs
NDC Faqs
NDC Overview
Converting HCPCS/CPT Units to NDC Units
Submitting NDCs on Professional Claims
Reimbursement Details
For More Information
NDC Overview
1. What is an NDC?
“NDC” stands for National Drug Code. It is a unique, 3-segment numeric identifier assigned to each
medication listed under Section 510 of the U.S. Federal Food, Drug and Cosmetic Act. The first segment
of the NDC identifies the labeler (i.e., the company that manufactures or distributes the drug). The
second segment identifies the product (i.e., specific strength, dosage form, and formulation of a drug).
The third segment identifies the package size and type. For billing purposes, the Centers for Medicare &
Medicaid Services (CMS) created an 11-digit NDC derivative, which necessitates padding of the labeler
(5 positions), product (4 positions) or package (2 positions) segment of the NDC with a leading zero,
thus resulting in a fixed-length, 5-4-2 configuration. (See question 12 for details.)
4. If the medication comes in a box with multiple vials, should I use the NDC number on the box or
the NDC number on the individual vial?
If the medication comes in a box with multiple vials, using the NDC on the box (outer packaging) is
recommended.
5. Which NDC units of measure should I submit on BCBSIL claims to help ensure appropriate
reimbursement?
Listed below are the preferred NDC units of measure and their descriptions:
UN (Unit) – Powder for injection (needs to be reconstituted), pellet, kit, patch, tablet, device
ML (Milliliter) – Liquid, solution, or suspension
GR (Gram) – Ointments, creams, inhalers or bulk powder in a jar
F2 (International Unit) – Products described as IU/vial or micrograms
Note: ME is also a recognized billing qualifier that may be used to identify milligrams as the NDC unit of measure; however, drug
costs are generally created at the UN or ML level. If a drug product is billed using milligrams, it is recommended that the milligrams
be billed in an equivalent decimal format of grams (GR). BCBSIL allows up to three decimals in the NDC Units (quantity or number
of units) field.
Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of
independent Blue Cross and Blue Shield Plans.
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Converting HCPCS/CPT Units to NDC Units
7. What information do I need to have ready before converting HCPCS/CPT units to NDC units?
Before you can fill out the claim to bill for a drug, you will need to know the following information:
Amount of drug to be billed
HCPCS/CPT code
HCPCS/CPT code description
Number of HCPCS/CPT units
NDC (11-digit billing format)
NDC description
NDC unit of measure
(Additional billing examples are included in the Submitting NDCs on Professional Claims section.)
To access the NDC Units Calculator Tool through Blue Access for Providers:
Look for the National Drug Codes (NDCs): Billing Resources box on our Provider website
Home page at bcbsil.com/provider.
If you are a new Blue Access for Providers user, you will need to select the Register now link.
Once registered, you will have access to the NDC Units Calculator tool, as well as other NDC
resources.
For additional information on using the NDC Units Calculator Tool, please refer to our NDC Billing
Tutorial, which is available to BCBSIL contracted providers on our secure Blue Access for Provider
website.
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13. Where do I enter NDC data on electronic claim (ANSI 5010 837P) transactions?
Here are general guidelines for including NDC data in an electronic claim:
Note: The total charge amount for each line of service also must be included for the Monetary Amount in
Loop ID, Segment SV102.
14. Are there any special software requirements to consider when NDCs are included on electronic
claims?
If you have converted to ANSI 5010, there should be no additional software requirements. Please verify
with your software vendor to confirm that your Practice Management System accepts and transmits the
NDC data fields appropriately. If you use a billing service or clearinghouse to submit electronic claims on
your behalf, please check with them to ensure that NDC data is not manipulated or dropped
inadvertently.
*Please note: You can bill for the entire vial size of the single-use vial, even though the actual dose administered is less than the
entire package size. Multi-use vials are not subject to payment for drug waste.
17. How many decimal places are allowed in the NDC units field?
BCBSIL allows up to three decimals in the NDC units (quantity or number of units) field. The more
specific your claim is, the more accurate the reimbursement, if any, will be.
18. How do I determine if the NDC is valid for the date of service?
When billing with NDCs on professional/ancillary electronic (837P) or paper (CMS-1500) claims, it is
important to ensure that the NDC used is valid for the date of service. This is because NDCs can expire
or change. An NDC’s inactive status is determined based on a drug’s market availability in nationally
recognized drug information databases.
Additionally, an NDC is considered to be obsolete two years after its inactive date. It is a good idea to
conduct a periodic check of records or automated systems where NDCs may be stored in your office for
billing purposes. To help ensure that correct reimbursement is applied, the 11-digit NDC on your claim
should correspond to the active NDC on the medication’s outer packaging. Inactive products will
continue to be reimbursed until they become obsolete.
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Reimbursement Details
20. How do I obtain NDC pricing information?
Contracted providers may obtain the NDC Reimbursement Schedule through Blue Access for Providers,
BCBSIL’s secure provider portal.
21. What if the reimbursement does not match the NDC allowable amount on the BCBSIL
Reimbursement Schedule?
First, review the NDC information you submitted. The NDC allowance on the NDC Reimbursement
Schedule equals one NDC unit of measure. Reimbursement will be based on the actual ratio of
HCPCS/CPT to NDC units of the product/service billed.
While some drugs may be administered as partial NDC units (i.e., 0.5 or 0.7), others may be 1 unit or
multiple NDC units (i.e., 2 or 5). The correct NDC units billed (whether partial, single or multiple) should
be used as the multiplier to determine the actual allowed amount.
If you have additional reimbursement questions, contact your assigned Provider Network Consultant for
assistance.
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The above information does not apply to claims submitted for HMO members.
CPT copyright 2014 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic
information exchange services to medical professionals. Availity provides administrative services to BCBSIL.
RJ Health Systems International, LLC is an independent third party vendor that is solely responsible for its products and services.
BCBSIL makes no representations or warranties regarding independent third party vendors. If you have any questions or concerns
about the products or services they offer, you should contact the vendor(s) directly.