5/27/2023 0 Comments Ndc unit calculator toolWhat information do I need to have ready before converting HCPCS/CPT units to NDC units? Before you can fill out the claim to bill for a drug, you will need to know the following information: Amount of drug to be billed HCPCS/CPT code HCPCS/CPT code description Number of HCPCS/CPT units NDC (11-digit billing format) NDC description NDC unit of measure Consider the following example for Ciprofloxacin IV 1200 MG (1 day supply): Amount of drug to be billed: 1200 MG HCPCS/CPT code: J0744 HCPCS/CPT code description: Injection, Ciprofloxacin for intravenous infusion, 200 MG Number of HCPCS/CPT units 6 NDC (11-digit billing format): NDC description: Ciprofloxacin IV SOLN 200 MG/20 ML NDC unit of measure ML 8. ![]() Return to page 1 Mayģ Converting HCPCS/CPT Units to NDC Units 7. Also, NDC pricing is normally updated on a monthly basis to reflect changes in drug cost. To save administrative time and effort in reviewing denials and resubmissions, BCBSMT systematically verifies the 11-digit NDC, and appropriate use of NDC units and HCPCS/CPT units submitted by providers. What are the advantages of using NDCs? Using NDCs on medical claims helps facilitate more accurate payment and better management of drug costs based on what was administered and billed. BCBSMT allows up to three decimals in the NDC Units (quantity or number of units) field. If a drug product is billed using milligrams, it is recommended that the milligrams be billed in an equivalent decimal format of grams (GR). ![]() Which NDC units of measure should I submit on BCBSMT claims to help ensure appropriate reimbursement? Listed below are the preferred NDC units of measure with examples: UN (Unit) Powder-filled vials for injection (needs to be reconstituted), pellet, kit, patch, tablet, device ML (Milliliter) Liquid, solution, or suspension GR (Gram) Ointments, creams, inhalers or bulk powder in a jar F2 (International Unit) Products described as IU/vial or micrograms Note: ME is also a recognized billing qualifier that may be used to identify milligrams as the NDC unit of measure however, drug costs are generally created at the UN or ML level. Continued on next page Blue Cross and Blue Shield of Montana, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Blue Cross, Blue Shield and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. If the medication comes in a box with multiple vials, should I use the NDC number on the box or the NDC number on the individual vial? If the medication comes in a box with multiple vials, using the NDC on the box (outer packaging) is recommended. The label also displays information about the NDC unit of measure for that drug. An asterisk may appear as a placeholder for any leading zeros. The number on the packaging may be less than 11 digits. Where do I find the NDC? The NDC is usually found on the drug label or outer packaging. As of May 1, 2015, professional and ancillary electronic claims for drugs must include NDC data in order to be processed by BCBSMT. When should NDCs be entered on claims? Blue Cross and Blue Shield of Montana (BCBSMT) will require the use of NDCs and related information, along with the applicable Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT ) code(s) when drugs are billed on professional and ancillary electronic (ANSI 837P) and paper (CMS-1500) claims. For billing purposes, the Centers for Medicare & Medicaid Services (CMS) created an 11-digit NDC derivative, which necessitates padding of the labeler (5 positions), product (4 positions) or package (2 positions) segment of the NDC with a leading zero, thus resulting in a fixed-length, configuration. ![]() The third segment identifies the package size and type. The second segment identifies the product (i.e., specific strength, dosage form, and formulation of a drug). The first segment of the NDC identifies the labeler (i.e., the company that manufactures or distributes the drug). It is a unique, 3-segment numeric identifier assigned to each medication listed under Section 510 of the U.S. What is an NDC? NDC stands for National Drug Code. 1 Billing with National Drug Codes (NDCs) Frequently Asked Questions NDC Overview Converting HCPCS/CPT Units to NDC Units Submitting NDCs on Professional/Ancillary Claims Reimbursement Details For More Information NDC Overview 1.
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