HCPCS	NDC	Convert Quantity
J9305	00002762301	HCPCS code is per 10mg and the product comes as a dry powder injection 500mg NDC units are “each vial” Dose was 100 mg, for example HCPCS quantity = 10 and the NDC quantity = 100/500 = 0.2 On the CMS-1500, enter: N400002762301 UN0.2 (see CMS-1500 example below)
J3110	00002897101	HCPCS code is for 10mcg and the product comes as 250mcg/ml NDC units are ml Dose was 750mcg HCPCS quantity = 75 and the NDC quantity = 3 On the CMS-1500, enter: N400002897101 ML3 (see CMS-1500 example below)
J1745	57894003001	HCPCS code is for 10mg and product comes as 100mg powder for injection. NDC units are "each vial" Dose was 200mg HCPCS quantity = 20 (20 x 10mg) = 200mg and the NDC quantity is 2. This is true even if the dry powder was reconstituted to 20ml On the CMS-1500, enter: N457894003001 UN2 (see CMS-1500 example below)

Billing with NDCs and Quantity

Use the following guidelines for reporting NDCs and quantities.

Remember that MN–ITS 837P/837I continues to be the most efficient and preferred method of submitting claims.

MN–ITS 837P and 837I

MN–ITS Interactive: On the Services tab, in the Drug Pricing box, enter the NDC that corresponds to the HCPCS code in the NDC field, and enter the quantity in the National Unit Count field.

MN–ITS Batch: Program your X12 software according to the standards in the DHS Companion Guide.

CMS-1500 Claim Form

The new CMS-1500 claim form, dated 08-05, accommodates NDC and quantity reporting. MHCP is providing a three-month transition period, from April 1, 2007, to July 1, 2007, for providers to begin reporting NDCs and quantities on the CMS-1500 claim form. Beginning July 1, 2007 MHCP will deny drug claims without NDCs.

Properly align paper forms for printing and adjust font size so that information does not cross over to other fields or from the shaded to the unshaded area. In the shaded area of the line-item box 24A-24G, left-justified, enter the qualifier N4 (no space or punctuation), the NDC (no dashes) that corresponds to the HCPCS/CPT code in box 24D, three spaces, the appropriate qualifier for the correct dispensing unit, and the quantity. Do not enter the name of the drug as shown in the example of the Minnesota CMS-1500 Manual. Use the example below for MHCP CMS-1500 billing.

Example:

UB-04 Claim Form

To date, the National Uniform Billing Committee (NUBC) has not determined the placement of NDCs for the UB-04 claim form. MHCP will post UB-04 billing instructions online when these instructions become available. Review remittance advice (RA) messages for notification.

Additional Resources