SCENARIO: Using the NDC

My payer is requiring that the NDC for the vaccine be included on the claim. Where does the code go on the claim form?

Inclusion of the NDC is not required by all payers. If a payer is requiring the inclusion of the NDC for a vaccine on a claim form, the first step is to make sure that the NDC is in an 11 digit format. Depending on the manufacturer, the NDC that appears on the carton or label may be in a format that is less than 11 digits. The chart below details how to convert NDCs that are less than 11 digits to the proper format.

If the NDC appears as…	Then the NDC…	And it is reported as…
NDC 12345-1234-12 (5-4-2 format)	Is complete	12345123412
NDC 1234-1234-1 (4-4-1 format)	Needs a leading zero placed at the beginning of the first segment and the last segment	01234123401
NDC 12345-123-12 (5-3-2 format)	Needs a leading zero placed at the beginning of the second segment	12345012312
NDC 12345-1234-1 (5-4-1 format)	Needs a leading zero placed at the beginning of the third segment	12345123401

If reporting the NDC on a CMS-1500 claim form it should be located in the shades area of Box 24A. The following table provides the elements of a proper NDC on a CMS-1500 claim form.

All Elements are REQUIRED:

How	Example	Where
Enter a valid NDC code including the N4 qualifier	NDC 00054352763 is entered as N400054352763	Beginning at left edge, enter NDC in the shaded area of box 24A
Enter one of the five (5) units of measure qualifiers; F2—International Unit GR—Gram ML—Milliliter UN—Units ME—Milligrams and quantity, including a decimal point for correct reporting	GR0.045 ML1.0 UN1.000	In the shared area immediately following the 11-digit NDC, enter 3 spaces, followed by one of five (5) units of measure qualifiers, followed immediately by the quantity
Enter a valid HCPCS or CPT Code		Non-shaded area of box 24D

How

Example

Where

Enter a valid NDC code including the N4 qualifier

NDC 00054352763 is entered as N400054352763

Beginning at left edge, enter NDC in the shaded area of box 24A

Enter one of the five (5) units of measure qualifiers;

F2—International Unit
GR—Gram
ML—Milliliter
UN—Units
ME—Milligrams

and quantity, including a decimal point for correct reporting

GR0.045
ML1.0
UN1.000

In the shared area immediately following the 11-digit NDC, enter 3 spaces, followed by one of five (5) units of measure qualifiers, followed immediately by the quantity

Enter a valid HCPCS or CPT Code

Non-shaded area of box 24D

If reporting the NDC electronically, you will need to notify your billing or software vendor that the NDC is to be reported in the following fields in the 837 format.

Tips for Using NDCs When Submitting Electronic Claims

Loop	Segment	Element name	Information	Sample
2410	LIN02	Product or Service ID Qualifier	Enter product of NDC qualifier N4	LIN*N401234567891~
2410	LIN03	Product or Service ID	Enter the NDC	LINn401234567891*~
2410	CTP04	Quantity	Enter quantity billed	CTP***2UN~
2410	CTP05-1	Unit of Basis for Measurement Code	Enter the NDC unit of measurement code: F2: International Unit GR: Gram ML: Milliliter UN: Unit ME: Milligram	CTP***2UN~

The FDA has required that vaccine manufacturers have different NDCs for the unit of sale (carton) and the unit of use (vial or syringe). Each payer may have a preference as to which NDC is submitted on claim forms and you may need to contact the specific payer to determine the NDC that is in their billing system.