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[New York] National Drug Codes (NDCs) are required for outpatient claims
Act
by Apr 17, 2026
Effective date
Apr 17, 2026
Identified
May 3, 2026
Summary
New York Medicaid now requires National Drug Codes (NDCs) in 11-digit 5-4-2 format for all outpatient claims with drug-related services billed using HCPCS codes. NDCs must match the actual product administered, include proper unit of measure (ML, UN, GR, F2), and be submitted without hyphens or spaces. Incorrect or missing NDC information will delay reimbursement.
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What to do
by Apr 17, 2026 · 13 steps
01Billing team must implement NDC submission requirements for all New York Medicaid outpatient claims with HCPCS drug codes.
02Update billing software to require 11-digit NDC format (5-4-2) with leading zeros for all drug-related line items.
03Configure system to validate NDC matches administered product (not box/bulk packaging).
04Train billing staff on proper unit of measure codes (ML for liquids, UN for powders/vials, GR for ointments/creams, F2 for international units).
05Add decimal quantity validation (max 8 digits before decimal, 3 after).
06Implement claim line edits to flag missing, incomplete, or invalid NDCs before submission.
07Verify HCPCS units match NDC units per policy examples.
08For compound drugs, require separate claim lines with modifiers KP (first) and KQ (subsequent).
09Exclude radiopharmaceuticals, hemophilia drugs, gene therapy, G codes, and P codes from NDC requirements.
10Update provider documentation and encounter forms to capture NDC from individual vial administered.
11Providers and billing staff must validate NDC accuracy on all CMS-1500, UB-04, and 837P/837I electronic submissions.
12Claims submitted without compliant NDC formatting will experience processing delays and potential denials.
13Use Availity Essentials resource section or call Provider Services (1-800-450-8753) for NDC crosswalk assistance.
Codes mentioned
J0177J0585J9271J2405J0696
Original notice
[New York] 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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