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

By April 17, 2026: Billing team must implement NDC submission requirements for all New York Medicaid outpatient claims with HCPCS drug codes. (1) Update billing software to require 11-digit NDC format (5-4-2) with leading zeros for all drug-related line items; (2) Configure system to validate NDC matches administered product (not box/bulk packaging); (3) Train billing staff on proper unit of measure codes (ML for liquids, UN for powders/vials, GR for ointments/creams, F2 for international units); (4) Add decimal quantity validation (max 8 digits before decimal, 3 after); (5) Implement claim line edits to flag missing, incomplete, or invalid NDCs before submission; (6) Verify HCPCS units match NDC units per policy examples; (7) For compound drugs, require separate claim lines with modifiers KP (first) and KQ (subsequent); (8) Exclude radiopharmaceuticals, hemophilia drugs, gene therapy, G codes, and P codes from NDC requirements; (9) Update provider documentation and encounter forms to capture NDC from individual vial administered. Providers and billing staff must validate NDC accuracy on all CMS-1500, UB-04, and 837P/837I electronic submissions. Claims submitted without compliant NDC formatting will experience processing delays and potential denials. Use Availity Essentials resource section or call Provider Services (1-800-450-8753) for NDC crosswalk assistance.