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[California] National Drug Codes (NDCs) are required for outpatient claims
Act
by Apr 20, 2026
Effective date
Apr 20, 2026
Identified
May 3, 2026
Summary
California Medicaid (Medi-Cal) now requires National Drug Codes (NDCs) in 11-digit 5-4-2 format for all outpatient claims that include drug-related services billed with HCPCS drug codes. NDCs must match the actual drug container administered, include proper unit of measure (UOM) codes, and be formatted without hyphens or spaces. Missing, incorrect, or misformatted NDC information will delay claim reimbursement.
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What to do
by Apr 20, 2026 · 12 steps
01Billing team must implement the following NDC submission requirements for all California Medicaid outpatient claims.
02Validate that all drug-related HCPCS codes include 11-digit NDCs in 5-4-2 format with leading zeros where applicable.
03Update billing software to automatically reject claims with missing, 10-digit, or incorrectly formatted NDCs.
04Configure system to require matching NDC from the individual vial/container administered (not bulk packaging).
05Establish UOM validation rules based on drug formulation type (UN for powder vials requiring reconstitution, ML for liquid formulations, GR for ointments/creams, F2 for international units).
06Ensure decimal quantities are supported (maximum 8 digits before decimal, 3 after) and zero-fill, commas, and spaces are removed.
07For CMS-1500 paper claims: enter NDC in Line 24A shaded area in format N4[11-digit NDC][UOM][quantity]; for UB-04: enter in Form Locator 43 without spaces; for electronic claims (837P/837I): populate LIN segment (LIN02: N4 qualifier, LIN03: 11-digit NDC) and CTP segment (CTP04: quantity, CTP05-1: UOM).
08Train billing and clinical staff on NDC location on drug containers and proper UOM selection.
09Audit claims for common errors including NDC/HCPCS unit mismatches, omitted quantities, and incorrect UOM codes.
10Claims submitted without compliant NDC information will experience processing delays and potential denials.
11Radiopharmaceuticals, hemophilia drugs, gene therapy, G Codes, and P Codes are exempt.
12For compound drugs, submit each NDC on separate line with KP/KQ modifiers.
Codes mentioned
J0177J0585J9271J2405J0696
Original notice
[California] 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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