Reminder on the use of National Drug Codes (NDC)

All providers must comply with the NJ Medicaid NDC requirements.

  1. When billing for “J” and “Q” codes, the appropriate NDC number, quantity, unit of measure and revenue code must be submitted. If this information is not submitted in the claim, NJ Medicaid requires Horizon NJ Health to deny the claim.

  2. NDC quantity must be valid. The calculated allowed amount (quantity X price) should not be more than two times the billed amount using billable (outer NDCs) wholesale acquisition cost. If the calculated amount exceeds this, NJ Medicaid requires us to deny the claim with the message “NDC quantity exceeded*.”

  3. Billable (outer NDCs) wholesale acquisition cost is required to calculate and valid NDC code in drug master for the date of service. The inner NDC is acceptable if it has the wholesale acquisition cost. It is recommended to use the outer NDC which will always have the wholesale acquisition cost.

For more information, visit Coding and Billing NDCs.
*Review example under Edit 330 on Coding and Billing NDCs.

 

Published on: August 1, 2019, 04:34 AM ET
Last updated on: August 1, 2019, 06:45 AM ET