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[Virginia] National Drug Codes (NDCs) are required for outpatient claims
Effective date
Apr 17, 2026
Identified
May 3, 2026
Summary
Virginia Medicaid (Anthem HealthKeepers) now requires National Drug Codes (NDCs) in 11-digit 5-4-2 format on all outpatient claims that include drug-related services billed with HCPCS drug codes. NDCs must match the actual product administered, be properly formatted with leading zeros, and include correct units of measure (UOM) to avoid claim denials and processing delays.
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What to do
Action · 9 steps
01Effective immediately for claims processed after April 17, 2026.
02Billing team must update all claim submission workflows to require NDC entry in 11-digit 5-4-2 format (with leading zeros) in the appropriate claim field (Line 24A for CMS-1500 paper claims, Form Locator 43 for UB-04 paper claims, or LIN segment for electronic 837P/837I claims).
03Implement validation rules in billing software to prevent submission of 10-digit NDCs and to ensure NDC matches the actual administered product (not box/bulk packaging).
04Providers and clinical staff must verify NDC on individual drug vials/containers at point of service and document for billing reference.
05Update all HCPCS drug code claims to include corresponding quantity and unit of measure (UOM) codes (UN for units/each, ML for milliliters, GR for grams, F2 for international units, ME for milligrams—avoid ME due to denial risk).
06Train billing staff on NDC-to-HCPCS unit matching using the Availity Essentials crosswalk in the Resource section.
07Establish process to handle compound drugs by reporting each NDC on separate line with modifiers KP (first drug) and KQ (subsequent drugs).
08Consequences: Claims with missing, incorrectly formatted, mismatched, or invalid NDCs will experience processing delays and reimbursement denials.
09Do not bill one manufacturer's product while submitting another manufacturer's NDC.
Codes mentioned
J0177J0585J9271J2405J0696
Original notice
[Virginia] National Drug Codes (NDCs) are required for outpatient claims
providernews.anthem.com · Always check the source before changing claims.
Related changes
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