Correct Coding for Commonly Injected Drugs
The Academy is currently updating the local coverage determination (LCD) policies for each Medicare Administrative Contractor (MAC). In the interim, please email firstname.lastname@example.org for questions regarding injection policies.
Table of Common Drugs
Use this table as a reference to help you learn more about the HCPCS office, HCPCS facility, description and units for commonly injectable drugs.
National Drug Code
The National Drug Code is a unique 10-digit, three-segment number. It is a universal product identifier for human drugs in the United States. The code is present on all nonprescription (over-the-counter) and prescription medication packages and inserts in the United States.
Listing Your National Drug Code (NDC) Number Correctly on Claims
Many NDC numbers listed on drug packaging are in 10 digit format. The NDC number is essential for proper claim processing when submitting claims for drugs used. However to be recognized by payers, it must be formatted into an 11 digit 5-4-2 sequence. This requires a zero to be placed in a specific position to meet the 5-4-2 format requirement. As not all NDC numbers are set up the same, the table below provides examples of appropriate position of the zero based on the three segment numbers listed on the packaging.
While many practice management systems automatically remove the hyphens, be sure they are excluded from submission on the claim.
|10 digit code
||NDC code for payer
||Avastin 100 mg vial
||Kenalog 5 mL vial