MedicaidBilling CodesHigh impact
Newsletter Vol. 17, No. 05
New Jersey Medicaid·NJ·Coding
Effective date
Apr 1, 2007
We identified it
Jun 20, 2026
Summary
Effective April 1, 2007, all claims for physician-administered and Medicare Part B-covered drugs must now include both the 11-digit National Drug Code (NDC) and the HCPCS procedure code on the CMS 1500 claim form. The NDC must be reported in Field 17a (paper claims) or Loop 2410 LIN03 (electronic 837P claims). Claims submitted without the required 11-digit NDC will be denied payment.
Action Required
By April 1, 2007: Billing team must immediately update claim submission procedures to capture and report the full 11-digit NDC code on all physician-administered and Medicare Part B-covered drug claims. For paper CMS 1500 claims, report NDC in Field 17a. For electronic 837P claims, report NDC in Loop 2410, fields LIN02 and LIN03. Providers must obtain NDC information from drug labels or suppliers and ensure it is populated in the billing system before claim generation. Validate all NDC codes using the State's Reference Drug File. Update billing software system to require NDC entry for all HCPCS codes J0120-J9999, Q0144-Q0181, Q4079-Q4081, Q9945-Q9964, Q3025-Q3026, Q2009, and Q2017. Train all billing staff on NDC capture requirements. Claims missing the required NDC will be denied payment by DMAHS. Exception: Hemophilia drugs submitted by pharmacy/medical suppliers continue to use pharmacy claims and are exempt from this requirement.