This guide covers how to enter National Drug Code (NDC) information on a claim. A professional claim (CMS 1500) is used for this example. NDC codes are added to each service detail line as needed.
Attention:
Refer to Appendix X - HCPCS / NDC Crosswalk for Billing Physician-Administered Drugs located on the Billing Manuals web page under the Appendices drop-down for the most current list of HCPCS codes and corresponding NDC numbers for use in billing physician-administered drugs.
A code must be present in the crosswalk before it can be used in a claim on the Web Portal. If the NDC is not found in the crosswalk, claims should be submitted via batch or paper.
The NDC is a unique product identifier used in the United States for drugs intended for human use. The Drug Listing Act of 1972 requires registered drug establishments to provide the Food and Drug Administration (FDA) with a current list of all drugs manufactured, prepared, propagated, compounded, or processed by it for commercial distribution. Drug products are identified and reported using the NDC.
- Enter the information needed for the claim on the Submit Professional Claim: Step 1 page and select Continue.
Note: Selecting a payer is now a required field. The “Payer” is the program that the provider is enrolled in. “Title XIX” is for Health First Colorado (Colorado’s Medicaid program) or Child Health Plan Plus (CHP+) through the Department of Health Care Policy & Financing.
Professional Claim
Enter the diagnosis type and diagnosis code information on the Submit Professional Claim: Step 2 page under "Diagnosis Codes" and select Add. Select Continue to go to the next step.
Professional Claim
On the Submit Professional Claim: Step 3 page, click the + to expand the NDC section.
Professional Claim
Enter the information in the "Service Details" and "NDCs for Svc" fields. NDCs are entered per service detail as needed. Select Add when finished.
Professional Claim
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