CLARIFICATION: Medication Billing of J-codes
To: Hospitals and Facilities
Contracts affected: Commercial and Medicare Advantage
All professional, ancillary or institutional claims, both outpatient and inpatient, that include J-code(s) must also include the valid NDC of the billed product.
This was effective October 1, 2019, but our previous notice only identified outpatient claims as requiring a valid NDC.
Details of this requirement:
- This applies to:
- Classified and unclassified (NOC) J-codes
- Electronic and paper claim submissions for J-codes
- The NDC must correspond with the Healthcare Common Procedure Coding System (HCPCS)
- As there are often several NDCs linked to a single HCPCS code, each NDC must be submitted on a separate claim line even if the HCPCS code is the same
- If the required NDC information is not included on claims submitted on or after October 1, 2019, the claim will be rejected
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