MedicaidBilling CodesHigh impact
Newsletter Vol. 19, No. 44
New Jersey Medicaid·NJ·Provider Notice
We identified it
Jun 20, 2026
Summary
New Jersey Medicaid (NJFC) requires physician-administered drug claims to include specific NDC formatting with 11-digit drug codes, metric quantities, and 2-digit unit of measure qualifiers in designated claim fields. Claims missing or incorrectly reporting this information will be denied. This change ensures compliance with Federal drug rebate regulations (42 CFR 447.520).
Action Required
Immediately: Billing team and software vendors must update billing systems to require and validate NDC reporting in Field 24A (CMS-1500) or Field LIN03 (837 electronic claims) with mandatory N4 qualifier prefix. Implement mandatory reporting of metric quantity in Field 24A or Field CTP04 (837) using format xxxxxxx.xxx. Implement mandatory 2-digit unit of measure qualifier reporting in Field 24A or Field CTP05 (837) using only GR (Gram), ML (Milliliter), or UN (Unit). Providers must verify software converts units correctly (e.g., micrograms to milligrams to milliliters) per drug strength on NDC. Use interactive webpage at www.njmmis.com under 'Physician Administered Drugs (UOM)' to identify correct NDC and UOM for each procedure code. Failure to implement these changes will result in claim denials under Error Codes 1214 (Invalid NDC), 1215 (Procedure/NDC Invalid), 1317 (Invalid/Missing Metric Quantity), and 1321 (Invalid UOM).