The NDC number, drug quantity, and package unit indicators are necessary on drug and vaccine claim filings when no nationally established Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) maximum allowable charge (CMAC) pricing has been set. Visit TRICARE's CMAC information to determine if a CMAC exists for specific drugs or vaccines.

EMC claims provide the fields for keying the NDC, drug quantity, and the package or unit indicator. This is in addition to the HCPCS/CPT drug code and quantity, which can be different from the NDC drug quantity. Where necessary, provide supporting documentation, such as the certificate of medical necessity (CMN), medical records, or NDC information. If you submit this form to PGBA through Faxgate, it will be attached to the electronic claim.

CMS-1500 hard-copy claims must use the shaded space above each line in the “Lines” field. These shaded areas are for additional information. The 11-digit NDC number (with no spaces or dashes), the drug quantity based on the NDC, and the “P” or “U” indicator should go in the shaded area. The actual line below the shaded area should include the appropriate HCPCS/CPT drug code, and the quantity based on the code must also be included in the “Lines” field. If needed, please include supporting documentation (such as CMN, medical records, or NDC information) with the claim submission.