New York Medicaid enforces NDC requirements for claims with HCPCS J-codes

New York Medicaid requires health care professionals to include the corresponding National Drug Code (NDC) when submitting claims for drugs with an HCPCS J-code. We will deny claims with a missing NDC or an NDC that doesn’t match the J-code. This requirement applies to all institutional claims for physician-administered drugs billed with a UD modifier. The UD modifier shows the drug was obtained at the 340B price.

Why this matters

The most common J-code/NDC mismatchesopen_in_new that New York State Department of Health identified as leading to claim denials are:

Incorrect drug
Incorrect route of administration
Incorrect package size

What you can do

To avoid claim denials, please use the CMS NDC crosswalk, ASP Pricing Filesopen_in_new, to match the J-code and NDC. Regularly review the crosswalk for updates and have a process in place for maintaining the information.

For more information, read the “National Drug Code Reporting Requirements” section of the New York State Medicaid Update – July 2022 Volume 38 – Number 8open_in_new.