December 7, 2017
Effective with dates of service January 1, 2018 and after, National Drug Codes (NDC) will be required on professional and outpatient claims.
This requirement applies to claims for any drug(s), radiopharmaceutical, or vaccine that's administered/supplied in an office or outpatient facility setting, by an individual physician or other qualified healthcare professional. The NDC will need to appear on either the CMS-1500 and UB-04 paper claim format or the 837P and 837I electronic claim format.
Billing and coding guidelines can be found in the following Payment Policies, accessible through the provider website.
If providers submit claims without an NDC code for administered drugs, we'll reject them and return them to you for correction.