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New Jersey MedicaidMedicaid · Billing Codes · Coding · NJ · NephrologyHigh impact

Newsletter Vol. 19, No. 50

Act
by Nov 1, 2009
Effective date
Nov 1, 2009
Identified
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.

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What to do

by Nov 1, 2009 · 7 steps
01Billing 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.
02For paper claims (UB-04 CMS-1450), format Field 43 as: N4[11-digit NDC][UOM][quantity] (e.g., N412345123412ML1.5).
03For electronic claims (837I), populate LOOP 2410 with NDC in LIN03, qualifier 'N4' in LIN02, metric quantity in CTP04, and UOM in CTP05.
04Train all billing staff on correct UOM selection using the NJMMIS website (www.njmmis.com).
05Update billing software vendor if necessary.
06Failure to report complete NDC and UOM information will result in claim denials under Error Codes 1214, 1317, or 1321.
07Do not apply this requirement to crossover Medicare/Medicaid claims.

Codes mentioned

J0120J9999Q0144Q0181Q4079Q4081Q0045Q9964Q3025Q3026Q2009Q2017

Original notice

Newsletter Vol. 19, No. 50
njmmis.com · Always check the source before changing claims.
View original ↗

Related changes

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Related policy hubs

New Jersey Medicaid policiesNJ policy changesNephrologyCode J0120Code J9999Code Q0144Code Q0181Code Q4079Code Q4081Code Q0045Code Q9964Code Q3025Code Q3026Code Q2009Code Q2017

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