Skip to main content
  • Ask the Expert Retina

    Commercial payer denying claims for Avastin


    Add to My Bookmarks

    Question: We are having issues with a commercial payer denying claims for Avastin? They are denying these claims stating that the National Drug Code (NDC) number should be 11 digits not 10. Any information is helpful:

      Answer: The NDC should be reported on the CMS 1500, item 24a in 5-4-2 format. The NDC should be preceded with N4 qualifier.

      Here is the example for Avastin, converting to 5-4-2 format:

      • 5-3-2 format - NDC 50242-060-01
      • 5-4-2 format - NDC code for payer 50242-0060-01

      Find additional information at Coding for Injectable Drugs