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New Jersey MedicaidMedicaid · Billing Codes · Coding · NJHigh impact

Newsletter Vol. 17, No. 05

Act
by Apr 1, 2007
Effective date
Apr 1, 2007
Identified
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.

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What to do

by Apr 1, 2007 · 9 steps
01Billing 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.
02For paper CMS 1500 claims, report NDC in Field 17a.
03For electronic 837P claims, report NDC in Loop 2410, fields LIN02 and LIN03.
04Providers must obtain NDC information from drug labels or suppliers and ensure it is populated in the billing system before claim generation.
05Validate all NDC codes using the State's Reference Drug File.
06Update billing software system to require NDC entry for all HCPCS codes J0120-J9999, Q0144-Q0181, Q4079-Q4081, Q9945-Q9964, Q3025-Q3026, Q2009, and Q2017.
07Train all billing staff on NDC capture requirements.
08Claims missing the required NDC will be denied payment by DMAHS.
09Exception: Hemophilia drugs submitted by pharmacy/medical suppliers continue to use pharmacy claims and are exempt from this requirement.

Codes mentioned

J0120J9999Q0144Q0181Q4079Q4081Q9945Q9964Q3025Q3026Q2009Q2017

Original notice

Newsletter Vol. 17, No. 05
njmmis.com · Always check the source before changing claims.
View original ↗

Related changes

See all New Jersey Medicaid changes →
Newsletter Vol. 17, No. 13HighEffective Aug 6, 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

Related policy hubs

New Jersey Medicaid policiesNJ policy changesCode J0120Code J9999Code Q0144Code Q0181Code Q4079Code Q4081Code Q9945Code Q9964Code Q3025Code Q3026Code Q2009Code Q2017

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