Billing with National Drug Codes
Blue Cross and Blue Shield of Texas (BCBSTX) currently accepts NDC for billing of all physicians or ancillary provider administered and supplied drugs. Effective Dec. 15, 2013, BCBSTX will begin reimbursing claims submitted with an NDC in accordance with the NDC Fee Schedule posted on the website under "Drugs". To locate this information, click the Standards & Requirements tab, then select General Reimbursement Information, enter password, then scroll down to the Reimbursement Schedules and Related Information area, then go to Professional and select the BlueChoice and HMO Blue Texas Schedules offering, then select 2013 Schedules effective Nov. 1, 2013, then scroll down to Drugs. The NDC Fee Schedule will be updated monthly on the first of the month, starting Jan. 1, 2014. Lower cost generic medications may be reimbursed with a larger margin compared to higher cost generic and brand medications. In addition, effective June 1, 2014, BCBSTX will revise the methodology utilized for determining the allowables for CPT and HCPCS codes associated with multiple NDCs. The HCPCS or CPT code allowable generally will be equivalent to the lowest NDC allowable associated with the HCPCS or CPT code.
When drugs are billed under the medical benefit on professional/ancillary electronic (ANSI 837P) and paper (CMS-1500) claims, it is important to include NDCs and related data. Using NDCs on medical claims facilitates more accurate payment and better management of drug costs based on what was dispensed. Physicians and ancillary providers are encouraged to begin including the NDC information on claims as soon as possible.
BCBSTX requires inclusion of the National Drug Code (NDC) along with the applicable Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®’) code(s) on claim submissions for unlisted or ― Not Otherwise Classified‖ (NOC) physician or ancillary provider administered and supplied drugs. BCBSTX will continue to accept the HCPCS or CPT code elements without NDC information (excluding unlisted or "Not Otherwise Classified" drugs).
As a reminder, when submitting NDCs on professional/ancillary electronic (ANSI 837P) and paper (CMS-1500) claims to BCBSTX, you must also include the following related information:
- The applicable Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) code
- Number of HCPCS/CPT units
- NDC qualifier (N4)
- NDC unit of measure (UN – Unit, ML – Milliliter, GR – Gram, F2 – International Unit)
- Number of NDC units (up to three decimal places)
- Your billable charge/price per unit
Attention electronic claim submitters: If you have converted to ANSI 5010, there should be no additional software requirements when NDCs are included on electronic claims. However, please verify with your software vendor to confirm that your Practice Management System accepts and transmits the NDC data fields appropriately. If you use a billing service or clearinghouse to submit electronic claims on your behalf, please check with them to ensure that NDC data is not manipulated or dropped inadvertently.
For additional information to assist you with using NDCs on medical claims, please refer to the Billing with National Drug Codes (NDC) information in the Claims and Eligibility/Submitting Claims section of our website at bcbstx.com/provider. You will also find other NDC-related resources on our website, such as answers to Frequently Asked Questions and an interactive online tutorial.
CPT Copyright 2012 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.