July 2020

Avoid National Drug Code (NDC) Billing Mistakes

Submitting claims with the appropriate NDC information may help with claims processing and may help you spend less time troubleshooting a rejected claim line.

When medication comes in a box with multiple vials, you may want to use the NDC on the box (outer packaging) to prevent claim rejections. Not all NDCs on individual vials have manufacturer pricing to support an allowance.

We have resources to assist you with NDC billing on our secure provider portal, Blue Access for Providers^SM. To register or log on, look for the “National Drug Codes (NDCs): Billing Resources” box on our Provider website.

Also refer to the Related Resources on the Claim Submission page for NDC Billing Guidelines, NDC Billing FAQs and an NDC Billing Update for Medicare Advantage Claims.

The material presented here is for informational/educational purposes only, is not intended to be medical advice or a definitive source for coding claims and is not a substitute for the independent medical judgment of a physician or other health care provider. Health care providers are encouraged to exercise their own independent medical judgment based upon their evaluation of their patients’ conditions and all available information, and to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly.