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Medical Coding Guidance

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NDC Numbers for New FDA Approved Radiopharmaceuticals

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Four diagnostic radiopharmaceuticals have new or NOC HCPCS Level II codes effective CY 2014 for reporting purposes.

NDC-New RPs Table Rev
NDC # Reporting requirements: Physicians’ offices, hospital outpatient departments and independent diagnostic testing facilities (IDTFs) serving patients who are dually eligible for Medicare and Medicaid and submit Claim Form UB-04 CMS-1450 and/or CMS-1500 paper or DDE (Direct Data Entry) claims to Medicare must report NDC#s for Medicaid rebate purposes. Additionally, for not otherwise classified (NOC) codes it is important to identify the drug including a radiopharmaceutical with the NDC number for the payer to identify and provide appropriate payment.

  • Claim Form CMS-1500 (02-12) Item No. 24 – Enter the 11 digit NDC# (without dashes) in the shaded area of line item No. 24 above the dates of service in the following order: N4 qualifier, NDC code, one space, unit/basis of measurement qualifier, and the quantity. The number of digits for the quantity is limited to eight digits before the decimal and three digits after the decimal. If entering a whole number, do not use a decimal. Do not use commas. When a dollar amount is being reported, enter the following after the quantity: one space, dollar amount. Do not enter a dollar sign. The following qualifiers are available when reporting NDC unit/basis of measurement: F2 (International Unit), GR (Gram), ME (Milligram), ML (Milliliter), UN (Unit). Use UN as the basis for the unit of measurement for the above radiopharmaceuticals.  Example using one billable unit: N412345678901 UN1.
  • Claim Form UB-04 CMS-1450 FL 43 – Enter the N4 qualifier in the first two (2) positions, left-justified; followed by the 11 digit NDC code in positions 03-13 (e.g., N412345678901). The Description Field on the UB-04 is 24 characters in length. Immediately following the NDC code, report the unit/basis of measurement qualifier (see CMS-1500 above) and the unit quantity with a floating decimal for fractional units limited to 3 digits (to the right of the decimal). Any spaces unused for the quantity are left blank.  Example using one billable unit: N412345678901UN1.

*Note: HCPCS Level II code A9520 was previously an active code for 99mTC Sulfur Colloid described per millicurie and then later deleted and changed. If you do a Google search for A9520 it commonly lists the deleted code. Lymphoseek was previously assigned HCPCS Level II code C1204 when it was given transitional pass-through status effective October 1, 2013 and has been replaced with a permanent HCPCS Level II Code A9520 effective January 1, 2013. Transitional pass-through status remains in effect for the hospital outpatient department (HOPPS) provider setting.

**Many National Drug Code numbers are displayed in a 10-digit format. Proper billing of a NDC# requires an 11-digit number. This format requires the addition of a strategically placed zero, depending on the format of the reported NDC#, i.e., 4-4-2, 5-3-2, 5-4-1. For Vizamyl (format 5-3-2) a zero would be placed before the 2nd set of digits, i.e., 99999-0999-99.