MedicaidBilling CodesHigh impact
Supplement 25-04: National Drug Code (NDC) Requirements When Billing for Drug Items Administered in Practitioners’ Offices, Outpatient Clinics, and Hospitals and 340B Coding Requirements
New Mexico Medicaid·NM·Pharmacy
Effective date
Feb 12, 2025
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid now requires all providers to include 11-digit National Drug Code (NDC) numbers when billing for any drug items administered in offices, clinics, or hospitals. Claims without valid NDC codes will be denied, and specific formatting requirements must be followed for CMS1500, UB04, and electronic claims.
Action Required
Immediately: Billing team must update all claim submission processes to include 11-digit NDC codes for any administered drugs. On CMS1500 forms, enter 'N4' qualifier followed by NDC code in box 24A shaded area. On UB04 forms, enter 'N4' followed by NDC in box 43. Update billing software to require NDC entry for all drug administrations. Train staff on NDC formatting rules (convert all NDCs to 5-4-2 format by adding leading zeros where needed). Claims without valid NDC codes will be denied by Medicaid's fiscal agent.