NDC Code

• NDC stands for National Drug Code and it is a universal product identifier for drugs used in the United States.

• It is a unique 10 digits or 11 digits number. It is originally 10 digit number but CMS (Centers for Medicare & Medicaid Services) created an 11-digit number by using a leading zero with the NDC code. When the NDC code is billed on the claim form, it always has 11 digit format.

• The NDC code has 3 segments:

        1) Labeler

        2) Product

        3) Package Size

• The Labeler code is assigned by U.S. Food and Drug Administration and it defines manufacturer, repackager, or distributor.

• The Product code is assigned by Labeler and it defines the specific strength, dosage form (Capsule, Tablet, Liquid) & formulation of a drug for a specific labeler.

• The Package code is assigned by Labeler and it defines package size and types.

• Format for NDC code with these 3 segments (Labeler-Product-Package Size) is 5-4-2, 6-3-2, 6-4-1.

• Drug CPT codes always have 1st character as a letter. Examples - J0256, J2425, J7649. 

• When a drug code needs to be billed to insurance then it is necessary to include the NDC code on a claim form (UB04 & CMS1500). Some insurances do not need this code but most of the insurances require the NDC code.

• In CMS1500 form, the NDC code is available in the shaded portion of the line item field 24A-24G as shown in below image,

• In the UB04 form, the NDC code is available in field 43 as shown in the below image,

     

• As you can see in both images, when an NDC code is billed on a claim form, it should have a format that includes the NDC Qualifier, NDC code, NDC unit of measure & number of NDC units.

        1) NDC Qualifier: "N4" Qualifier needs to bill with the NDC code.

        2) NDC Code: Uniques 11 digits number assigned to each drug code.

        3) NDC unit of Measure: There are 4 units to measure drugs,

• UN (Unit) – Powder-filled vials for injection (needs to be reconstituted), pellet, kit, patch, tablet, and device.
• ML (Millilitre) – 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.

        4) NDC Units: These define the quantity of the drugs.