MedicaidBilling CodesHigh impact
Supplement 21-02: National Drug Code (NDC) and 340B Drug Rebates
New Mexico Medicaid·NM·Pharmacy
Effective date
May 1, 2021
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid now requires 11-digit National Drug Code (NDC) numbers and 340B modifiers for all physician-administered drugs billed with HCPCS or CPT codes in office, clinic, and hospital outpatient settings. Claims without valid NDC codes will be denied starting May 1, 2021.
Action Required
By May 1, 2021: Billing team must update billing software to include 11-digit NDC codes for all administered drugs. On CMS1500 forms, enter NDC in box 24A with qualifier 'N4' followed by 11-digit NDC plus unit of measure (F2, GR, ML, or UN). On UB04 forms, enter NDC in box 43 with 'N4' qualifier. Providers using 340B drugs must either carve out of Medicaid billing or use actual acquisition cost with manufacturer NDC. Claims without valid NDC codes will be denied by Medicaid's Fiscal Agent.