Reminder: National Drug Codes Required for Select Drugs Effective July 2022

Jul. 18, 2022 Update: This communication originally posted on May 23, 2022 has been reposted as a reminder.

Effective July 26, 2022, Blue Cross Blue Shield of North Carolina (Blue Cross NC) will require specific drug codes to be submitted with a valid National Drug Code (NDC) to be eligible for reimbursement. 

A valid NDC number for the administered drug will be required for reimbursement of professional drug claims on a CMS-1500 claim form, and on a UB-04 claim form for outpatient drug claims. NDC information that is invalid, missing, or not matching the HCPCS or CPT code submitted, will not be eligible for reimbursement. 

The NDC was created under the direction of the United States Federal Food, Drug, and Cosmetic Act. NDC numbers are the industry standard identifier for drugs and provide full transparency to the medication administered. The NDC number identifies the manufacturer, drug name, dosage, strength, package size and quantity. This change is being implemented to increase the accuracy of provider reimbursement. 

For a complete list of drug codes requiring an NDC.  Please see the reimbursement policies here for Commercial and here for Medicare. 

This coding requirement will apply to all Blue Medicare and commercial fully-insured under 65, Administrative Services Only (ASO), and Blue Card/InterPlan Program Host members.    

If you have any questions about this change, please call the Provider Blue Line ^SM at 1-800-214-4844.