DHCS/MediCal: NDC Reporting

Beginning September 1, 2008, providers are encouraged to begin using the National Drug Code (NDC) for physician-administered drugs, in conjunction with the customary Healthcare Common Procedure Coding System (HCPCS) Level I, II, or III code, on all Medi-Cal claims. Claims for dates of service September 1, 2008 through March 31, 2009 that do not include an NDC will not be denied. However, for claims with dates of service on or after April 1, 2009 that do not meet the NDC reporting requirements of a valid NDC present with the HCPCS code, will result in that claim being denied.

As you are aware, the Deficit Reduction Act of 2005 (DRA) requires all state Medicaid Agencies to collect rebates from drug manufacturers for physician-administered or dispensed drugs. This requirement also applies to Medicare crossover claims. Only those products manufactured by companies participating in the federal Medicaid rebate program are reimbursable under Medi-Cal. A list of manufacturers participating in the rebate program, which changes periodically, is available in the Medi-Cal pharmacy manual under Drugs: Contract Drugs List Part 5 – Authorized Manufacturer Labeler Codes (drugs cdl p5) or on the Medi-Cal website at: http://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/drugscdlp5_p00.doc

This email is advance notice that the Department of Healthcare Services (DHCS) will soon be publishing the details regarding NDC reporting requirements. All documentation, such as Medi-Cal Updates and Companion Guides, are currently being updated. Those details include: NDC and physician-administered drug definitions; billing descriptions and examples for CMS 1500 and UB-04 paper claim forms, as well as both 837 Institutional and Professional electronic formats; and Section 340B information.

Should you have any questions or need additional information, please call the Telephone Service Center (TSC) at 1-800-541-5555 or visit the Medi-Cal Web site at the address listed above.