NDC billing follows a specific process that involves including the “N4” qualifier, the 11-digit medication NDC number, and the unit/basis value in a specific format in specific places on your claims. While this is helpful and possibly required by some payers, this is not the NDC billing we are discussing here. Many offices I work with have started adding the medication NDC number on their claims without any additional qualifier or NDC units. There is an important difference between simply putting the NDC number of a medication on a claim form vs. When I refer to NDC billing, I am speaking specifically about the NDC billing requirement for physician’s offices and stand-alone Infusion Centers who bill for medications through a patient’s medical benefit. Now that you have a good primer on NDCs, we can move onto NDC billing. (Or, you can use WeInfuse and we do this conversion for you ) If not, you will have to do some “googling” or reach out to the manufacturer of the product for help. This is easy if you have the hyphenated NDC number as shown.
To convert a 10 digit NDC number into the correct 11 digit format, you simply add a zero in the correct location as shown in the above guide. As we will cover in more detail, it is important to convert any 9 or 10 digit NDC number to an 11 digit NDC for proper NDC billing. The 11 digit NDC format is the newest format which means there are still many 10 digit NDC numbers floating around in the market. The remaining digits are assigned by the manufacturer and identify the specific product and package size. The first five digits identify the manufacturer (labeler) of the drug and are assigned by the FDA. <- 11-digit NDC number for Genentech’s Actemra 400mg vial NDC stands for “National Drug Code” and is currently an 11 digit segmented numeric value assigned to all drugs that are “manufactured, prepared, propagated, compounded, or processed…for commercial distribution.” – from FDA’s NDC Webpage NDCs are typically segmented and separated by hyphens to help with their identification. In this writing, I will cover the process and my best understanding of the NDC Billing Format. Start with Billing for Infusion Time – “The Confusion of Infusion Billing” then HCPCS Billing for Medications – “Billing Infusion Medications” as pre-requisites to this guide.įor this article, I will use the term “infusion billing” to generically describe billing for any injectable product – infusion (IV), intramuscular (IM), subcutaneous (SQ), etc. If you have not already, be sure to review our previous blog entries before moving on. RJ Health Systems International, LLC is an independent third-party vendor that is solely responsible for its products and services.If you have been following our WeInfuse IV Insights Blog for a while, then you are already familiar with our previous articles about billing for infusion and injectable products in the physician’s in-office infusion suite and in stand-alone Infusion Centers. RC Claim AssistTM is a product of RJ Health Systems. RC Claim AssistTM Copyright 2021 RJ Health Systems International, LLC. BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer. Availity provides administrative services to BCBSMT. CPT is a registered trademark of the AMA.Īvaility is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Be sure to include your name, direct contact information, Tax ID and/or billing NPI.ĬPT copyright 2021 American Medical Association (AMA). Questions?Įmail our Provider Education Consultants.
#NDC UNIT CALCULATOR TOOL REGISTRATION#
For registration help, call Availity Client Services at 80.įor navigation help and other details, refer to the NDC Units Calculator Tool User Guide. You can sign up today at Availity, at no charge. You must be registered with Availity to access to the NDC Units Calculator tool via Availity. The NDC Units Calculator is accessible in the Blue Cross and Blue Shield of Montana (BCBSMT) branded Payer Spaces section via the Availity ® Essentials portal. This tool (also known as RC Claim Assist ™) is hosted by RJ Health Systems, an independent third-party pharmaceutical specialty company. The NDC Units Calculator is a user-friendly online tool that allows providers to convert applicable classified or specified Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) codes to NDC units.
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