National Drug Code (NDC) Billing for Healthcare Common Procedure Coding System (HCPCS)

The Deficit Reduction Act of 2005 requires Medicaid agencies, including the Oklahoma Health Care Authority, to collect national drug code numbers on pharmaceuticals administered in outpatient settings.

  • NDC required for claims filed on a CMS 1500 (or electronic equivalent) for dates of service on or after Jan. 1, 2008
  • NDC required for claims filed on a UB-04 (or electronic equivalent) for dates of service on or after July 1, 2008
  • All eleven digits of the NDC must be reported on the claim

What is an NDC?

The NDC number is an 11-digit code assigned to all pharmaceuticals. The number is in a 5-4-2 format and can be found on product packaging. The first five numbers refer to the labeler (manufacturer) code; the next four numbers refer to the product code; the final two numbers refer to the package code.
 

 

 

99999

9999

99

Labeler Code

(5 digits)

Product Code

(4 digits)

Package Code

(2 digits)

  

  

  

Why is this important?

The NDC information is necessary to collect rebates from drug labelers. If a labeler does not participate in the federal rebate program, then OHCA cannot pay for any of its products.

Where can I find more information?

The Centers for Medicare and Medicaid Services publishes a reference list of labelers participating in the federal drug rebate program.

The SoonerCare secure site can be used to check a specific NDC’s coverage.

In general, all HCPCS codes associated with drugs administered in outpatient settings require a NDC for billing. Exceptions are vaccines, devices, and radiopharmaceuticals.