Billing Guidance to Include National Drug Codes (NDCs) in Drug Claim Lines
When submitting drug claims, please bill your usual and customary charge for the drug and populate it in the charge field of the claim.
NDC numbers are required on all drugs submitted with a Current Procedural Terminology and Healthcare Common Procedure Coding System (CPT/HCPCS) code. For dates of service on or after January 1, 2019, please refer to this billing rule communication.
Billing pharmacy charges under revenue code 0250 and populating the NDC without a HCPCS code is not appropriate. Use of Not Otherwise Classified (NOC) codes is appropriate if there is no HCPCS Level II code or CPT code available that describes the service. Please report these drugs under revenue code 0636 using the NOC code(s) and the NDC number.
MaineCare may not have particular CPT/HCPCS and NDC combinations available in MIHMS. Providers must check the Health PAS Online Portal to confirm that MaineCare covers the CPT/HCPCS and that the CPT/HCPCS and NDC combination is valid. If the combination is not valid, submit an NDC-J Code Combination Request Form to add the combination to MaineCareNDCrequest.DHHS@maine.gov.
MaineCare collects rebates from manufacturers on drugs. Claims are routinely audited for inclusion of all necessary information such as CPT/HCPCS codes and NDC numbers by the Office of Inspector General, MaineCare, and manufacturers.
Please contact Megan Dinsmore, Provider Relations Specialist, with questions.
Check out our new MaineCare logo! Learn more about this logo on the About Us page of our website.
