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Newsletter Vol. 17, No. 13
Act
by Aug 6, 2007
Effective date
Aug 6, 2007
Identified
Jun 20, 2026
Summary
New Jersey requires providers to report the 11-digit National Drug Code (NDC) in addition to HCPCS procedure codes for all physician-administered and Medicare Part B-covered drugs on CMS-1500 claims (paper and electronic). Effective August 6, 2007, claims submitted without the NDC will be denied. Paper claims must use the 0805 version of the CMS-1500 form with NDC reported in Field 24A upper-horizontal area with specific formatting requirements.
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What to do
by Aug 6, 2007 · 9 steps
01Billing team must immediately implement NDC reporting for all physician-administered and Medicare Part B-covered drug claims submitted to New Jersey Division of Medical Assistance & Health Services.
02Update billing software to capture and validate 11-digit NDC numbers in Field 24A (paper CMS-1500 0805 version) or Loop 2410 LIN03 (837P electronic format).
03Providers must report NDC using format: N4[11-digit NDC][3 spaces][Unit of Measure qualifier][Quantity] (e.g., N412345123412 ML1.5).
04Unit of Measure qualifiers required: F2 (International Measure), GR (Gram), ML (Milliliter), UN (Unit).
05For paper claims, transition all providers to CMS-1500 (0805) version form.
06Train billing staff on NDC formatting requirements and validation against State Reference Drug File.
07Configure claims to validate that NDC corresponds to HCPCS code billed in Field 24D.
08CONSEQUENCE: Claims submitted without 11-digit NDC will be automatically denied payment by DMAHS.
09This applies to all drug HCPCS codes J0120-J9999, Q0144-Q0181, Q4079-Q4081, Q9945-Q9964, and Q3025, Q3026, Q2009, Q2017, plus inhalation solutions, chemotherapy, immunosuppressants, and hemophiliac drugs administered via DME.
Codes mentioned
J0120J9999Q0144Q0181Q4079Q4081Q9945Q9964Q3025Q3026Q2009Q2017
Original notice
Newsletter Vol. 17, No. 13
njmmis.com · Always check the source before changing claims.
Related changes
See all New Jersey Medicaid changes →Newsletter Vol. 17, No. 05HighEffective Apr 1, 2007 · CodingNewsletter Vol. 19, No. 18HighEffective Jun 8, 2009 · PharmacyNewsletter Vol. 19, No. 50HighEffective Nov 1, 2009 · CodingNewsletter Vol. 32, No.07HighNo effective date · Provider NoticeBrowse every New Jersey Medicaid change in the policy list