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…|
|Needs a leading zero placed at the beginning of the first segment and the last segment||01234123401|
|Needs a leading zero placed at the beginning of the second segment||12345012312|
|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:
|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;
and quantity, including a decimal point for correct reporting
|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
|2410||LIN02||Product or Service ID Qualifier||Enter product of NDC qualifier N4||LIN**N4*01234567891~|
|2410||LIN03||Product or Service ID||Enter the NDC||LIN**n4*01234567891~|
|2410||CTP04||Quantity||Enter quantity billed||CTP****2*UN~|
|2410||CTP05-1||Unit of Basis for Measurement Code||Enter the NDC unit of measurement code:
F2: International Unit
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.