MedicaidBilling CodesHigh impact
Reporting of the National Drug Code (NDC) on Outpatient Institutional Claims
Illinois Medicaid - HFS·IL · Nephrology, General Surgery·Provider Notice
Effective date
Jul 1, 2008
We identified it
Jun 21, 2026
Summary
Illinois Medicaid now requires National Drug Code (NDC) reporting on outpatient institutional claims for physician-administered drugs to collect manufacturer rebates. Mandatory reporting begins July 1, 2008, with informational messages starting May 1st to help providers transition.
Action Required
By July 1, 2008: Billing team must update institutional claim systems to include 11-digit NDC codes in 5-4-2 format for all physician-administered drugs, especially Epogen (Q4081) under revenue codes 634/635 and other injectables under revenue code 636. Configure systems to handle multiple NDCs per HCPCS code when needed. Claims missing required NDCs will be paid without add-on payments after July 1st.