Placement of an NDC when filing a claim:
If billing on a paper claim, an original Red & White form must be used – not a copy of an original.
UB-04 location – Box 43 (Please refer to the NUBC for additional guidelines)
837 Institutional Outpatient – At the Service tab use the Rx Indicator field to switch from N to Y to bill with a NDC number. This will populate a Rx tab.
In the Rx tab there will be three fields: NDC number, Units (Unit Quantity), and Basis of measurement -(Unit of Measurement Qualifier).
Note: You will be able to input 10 NDCs per detail.
CMS 1500 location – Box 24A (shaded area) (Please refer to NUCC for additional guidelines)
National Drug Code (NDC) Requirement – UB-04
In order to collect rebates from the correct manufacturers, VT Medicaid will require data elements at the detail level in addition to the HCPCS codes. These elements are the 11 digit National Drug Code (NDC) number, the Unit of Measurement Qualifier code, and the unit quantity. These must be reported on paper and electronic submissions of all outpatient claims.
The NDC billing requirement will apply to all details where HCPCS reporting is required.
Requirement on UB04 Form:
• Field 42: Revenue Code
• Field 43: NDC 11 digit number, Unit of Measurement Qualifier and Unit Quantity
• Field 44: HCPCS Code
42. Rev CD 43. Description 44. HCPCS/Rate 45. Serv.Date 46. Serv Units
636 [UN][1111.234] HCPCS Code 07/01/2020 HPCPS Units
11 Digit Unit of Unit
NDC Measurement Quantity
Unit of Measurement Qualifier
F2 – International Unit
GR – Gram
ML – Milliliter
UN – Unit