MedicaidBilling CodesHigh impact
Newsletter Vol. 19, No. 50
New Jersey Medicaid·NJ · Nephrology·Coding
Effective date
Nov 1, 2009
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid requires hospitals and freestanding ESRD facilities to report the 11-digit National Drug Code (NDC), unit of measure (UOM), and metric quantity for all outpatient-administered drugs on claims, effective November 1, 2009. This federal requirement ensures proper drug rebate billing and claim validation. Claims submitted without complete NDC and UOM information will be denied.
Action Required
By November 1, 2009: Billing team must update all billing systems and processes to capture and report 11-digit NDC numbers, unit of measure codes (GR, ML, UN), and metric quantities for outpatient-administered drugs billed under Revenue Codes 634, 635, 636, and 637. For paper claims (UB-04 CMS-1450), format Field 43 as: N4[11-digit NDC][UOM][quantity] (e.g., N412345123412ML1.5). For electronic claims (837I), populate LOOP 2410 with NDC in LIN03, qualifier 'N4' in LIN02, metric quantity in CTP04, and UOM in CTP05. Train all billing staff on correct UOM selection using the NJMMIS website (www.njmmis.com). Update billing software vendor if necessary. Failure to report complete NDC and UOM information will result in claim denials under Error Codes 1214, 1317, or 1321. Do not apply this requirement to crossover Medicare/Medicaid claims.