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NDC Requirements
Description
The National Drug Code (NDC) was created under the direction of the United States Federal Food, Drug, and Cosmetic Act. NDC numbers are the industry standard identifier for drugs and provide full transparency to the medication administered. The NDC number identifies the manufacturer, drug name, dosage, strength, package size and quantity.
Policy
Blue Cross Blue Shield North Carolina (Blue Cross NC) will require a valid National Drug Code (NDC) according to the criteria outlined in this policy.
Reimbursement Guidelines
A valid NDC number for the administered drug will be required for reimbursement of professional drug claims on a CMS-1500 Claim Form, and on a UB-04 Claim Form for outpatient drug claims.
NDC information that is invalid, missing, or not matching the HCPCS or CPT® code submitted, will not be eligible for reimbursement.
Rationale
The United States Federal Food, Drug, and Cosmetic Act, under Title 21, Chapter 9, Subchapter V, created unique numeric identifiers for the manufacturer, product, and package size to establish unique NDCs.
Blue Cross North Carolina (Blue Cross NC) requires specific drug codes to be submitted with a valid NDC to be eligible for reimbursement.
Requiring NDCs will enable Blue Cross NC to identify and reimburse for provided services more accurately.
Billing and Coding
Please refer to the Blue Book Provider Manual for code filing instructions.
Applicable codes are for reference only and may not be all inclusive. For further information on reimbursement guidelines, please see the Blue Cross NC web site at www.bcbsnc.com.
Related policy
Drug and Biological Wastage
References
The Blue Book Provider Manual (PDF)
21 USC Chapter 9, Subchapter V: Drugs and Devices
History
5/17/2022 New policy developed. Medical Director approved. Notification on 5/17/2022 for effective date 7/26/2022. (ckb)
12/31/2022 Routine policy review. Minor revisions only. (ckb)
12/31/2024 Update: HCPCS Codes removed from Billing and Coding section. (wt)
Application
These reimbursement requirements apply to all commercial, Administrative Services Only (ASO), and Blue Card Inter-Plan Program Host members (other Plans members who seek care from the NC service area). This policy does not apply to Blue Cross NC members who seek care in other states.
This policy relates only to the services or supplies described herein. Please refer to the Member's Benefit Booklet for availability of benefits. Member's benefits may vary according to benefit design; therefore, member benefit language should be reviewed before applying the terms of this policy.
Disclosures:
Reimbursement policy is not an authorization, certification, explanation of benefits or a contract. Benefits and eligibility are determined before medical guidelines and payment guidelines are applied. Benefits are determined by the group contract and subscriber certificate that is in effect at the time services are rendered. This document is solely provided for informational purposes only and is based on research of current medical literature and review of common medical practices in the treatment and diagnosis of disease. Medical practices and knowledge are constantly changing and Blue Cross NC reserves the right to review and revise its medical and reimbursement policies periodically.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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