When submitting claims for injectable drugs, it is important to pay attention to the details, such as the National Drug Code (NDC) number, drug quantity and package unit (P/U) indicators. Including these essential pieces of information on all injectable drug claims will ensure accurate pricing and speedy payment of all injectable drugs administered by providers.

Electronic Claims Submission

Electronic media claims provide the fields for keying the NDC, drug quantity and the package or unit indicator, in addition to the HCPCS/CPT drug code and quantity, which can be different from the NDC drug quantity. Where necessary, please provide supporting documentation such as the certificate of medical necessity (CMN), medical records or NDC information. This can be submitted to PGBA, LLC through FAXGATE and will be attached to the electronic
claim.

When billing paper claims using the CMS-1500 claim form (08/05 version), providers must follow these guidelines for proper claims processing and payment:

• In the CPT/HCPCS column directly above the line in section 24D, include the appropriate CPT/HCPCS code and the quantity.
• In the shaded area above the actual CPT/HCPCS code, you must include the 11-digit NDC number (with no spaces or
  dashes), the drug quantity based on the NDC and the P or U indicator.

Remember, if supporting documentation (such as CMN, medical records or NDC information, etc.) is needed, please include it with the submission of the paper claim.

  
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Created: June 14, 2007