MedicaidBilling CodesHigh impact
Policy Clarification Regarding the Reporting of National Drug Code (NDC)
Illinois Medicaid - HFS·IL·Provider Notice
Effective date
Jul 1, 2006
We identified it
Jun 21, 2026
Summary
Illinois Medicaid requires National Drug Code (NDC) reporting on all drug claims starting July 1, 2006. Providers must report both HCPCS codes and NDCs in specific formats, with NDCs converted to 5-4-2 configuration and billed on separate service lines with zero charges.
Action Required
By July 1, 2006: All providers administering or dispensing drugs must update billing systems to report NDCs alongside HCPCS codes. Convert all NDCs to 5-4-2 configuration by adding leading zeros as needed. For paper claims, bill HCPCS code on one line, then NDC on next line with zero charge and container/package quantity. For electronic claims, follow HIPAA 837P format requirements. Update billing software to handle multiple NDC scenarios with appropriate modifiers (76 for repeat procedures, 51 for multiple procedures). Claims without NDCs will not maximize federal rebates.