Reminder: National Drug Code Required When Submitting Claims for Drugs Covered Under the Medical Benefit

By September 1, 2026: Billing team must implement the following changes: (1) Update all billing system validation rules to require and enforce 11-digit NDC format (5-4-2) with leading zeroes for all drug claims with HCPCS codes; (2) Configure electronic submission software (837P and 837I) to populate NDC in Loop 2410 (LIN02: N4 qualifier, LIN03: 11-digit NDC) and quantity/unit in CTP segment; (3) Update paper claim templates (CMS-1500 Line 24A and UB-04 Line 43) to include formatted NDC entry fields with unit of measure qualifiers; (4) Establish verification process to confirm NDC matches product administered and is active for date of service; (5) Create staff training materials on proper NDC formatting, including rules for leading zeroes and partial unit decimals (max 8 digits before decimal, 3 after); (6) Audit all pending/queued drug claims to ensure NDC compliance before September 1 deadline. Before September 1, 2026: Providers and clinical staff must identify all drug administration points and verify NDC information on drug containers at point of dispensing. Consequence: All claims submitted without complete and accurate NDC information will be rejected or returned for resubmission beginning September 1, 2026, causing payment delays.