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National Drug Code (NDC) Implementation Update

July 12, 2011

Since October 2010, Blue Cross and Blue Shield of Illinois (BCBSIL) has required all home infusion/specialty pharmacy drugs to be billed with the appropriate National Drug Code (NDC) and NDC-related information (qualifier, unit of measure, number of units, price per unit), in addition to the applicable Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT®) code(s) on professional claims.

Previously, we announced that NDCs would be required effective July 1, 2011, for drugs administered in physician offices and billed on professional claims. While working collaboratively with the provider community and their electronic trading partners (billing services and clearing houses), we understand that they may need more time to prepare, prior to transitioning to use of NDCs. We have therefore decided to postpone implementation of NDC pricing until Sept. 1, 2011.

  • In the interim, claims will be accepted without NDC information, and will continue to be paid based on J code.
  • Beginning Sept. 1, 2011, claims must include the NDC and related information (qualifier, unit of measure, number of units, price per unit), along with the appropriate HCPCS or CPT code.
  • Once NDC pricing is implemented, claims submitted without NDCs and related information, as required, will no longer be accepted.

If you have the ability, we encourage you to begin including NDCs when billing BCBSIL for drugs on your professional claims. This way, you can become accustomed to interpreting the NDC information on the package label, based on how the drug is administered to the patient, in order to appropriately transfer that information to your claim.

BCBSIL values the working relationships we maintain with our independently contracted providers and health information technology vendors. Please continue to watch the Blue Review for updates and information, such as NDC billing examples. For details on what information is required and where it should be included on your electronic (837P) or paper (CMS-1500) claims, refer to the NDC billing guidelines for professional claims.

CPT copyright 2010 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.