[Virginia] National Drug Codes (NDCs) are required for outpatient claims

Effective immediately for claims processed after April 17, 2026: (1) Billing 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). (2) Implement 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). (3) Providers and clinical staff must verify NDC on individual drug vials/containers at point of service and document for billing reference. (4) Update 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). (5) Train billing staff on NDC-to-HCPCS unit matching using the Availity Essentials crosswalk in the Resource section. (6) Establish process to handle compound drugs by reporting each NDC on separate line with modifiers KP (first drug) and KQ (subsequent drugs). Consequences: Claims with missing, incorrectly formatted, mismatched, or invalid NDCs will experience processing delays and reimbursement denials. Do not bill one manufacturer's product while submitting another manufacturer's NDC.