Friday, June 3, 2016

All info about NDC CODE - When to use UN, ML,GM with example


NDC Code

An NDC (National Drug Code) is a unique identifier which identifies a specific drug. Even though an NDC Code is assigned to a drug, the drug may not be approved by the FDA. The NDC code(s) reported by the manufacture is the billable NDC code and is generally found on the drug container (i.e. vial, bottle, tube, etc).

 Note: In select instances, the manufacture reports the NDC code on the drug package which would be the billable NDC code based upon this being the NDC Code reported by the manufacture.

When coding a claim, the following NDC information is required to identify the drug services provided and prevent the services from being rejected:

• NDC Qualifier (N4)

• NDC Code (11 digits-see below)

• NDC Description (optional)

Refer to the below instructions for converting NDC codes into an 11-digit format (5-4-2) when the drug’s NDC code is fewer than 11 digits:

NOTE - Any NDC code that is billed outside of the 11-digit format will be rejected.


Digit NDC format is         Then add a zero (0) in         Report NDC as

4-4-2 (9999-9999-99)       first position, 09999-9999-99       09999999999

5-3-2 (99999-999-99)       sixth position, 99999-0999-99       99999099999

5-4-1 (99999-9999-9)      tenth position, 99999-9999-09       99999999909


NDC Quantity

NDC Quantity is based on the National Council for Prescription Drug Programs (NCPDP) standard billing units per NDC. The NDC Quantity identifies the drug dosage amount submitted for the NDC Code billed. In order to accurately report the NDC Quantity, the Unit of Measurement (UoM) assigned to the NDC Code must be applied and used to calculate the dosage amount. The dosage amount billed in the NDC Quantity must be billed with the actual metric decimal quantity (up to two decimal places) for the unit of measurement assigned to the NDC to prevent the services from being denied or underpaid. Note: The NDC quantity must be rounded up to 0.01 in the metric quantity is less than 0.01 (i.e. 0.003, 0.0014, etc) There are four valid values (F2, ML, GR, UN) that can be used when reporting the unit of measurement. Each NDC Code is assigned a single UoM for the drug based upon how the drug is supplied. Below is the unit of measurement descriptions and examples to assist with determining the unit of measurement (UoM) assigned to the NDC code to calculate the appropriate NDC quantity when billing claims.

• UN (Unit) - used when the products are dispensed in discreet units or vials that are powder form and have to be reconstituted before administration. These products are not measured by volume or weight. The NDC Code's reporting billing unit of "EA" applies to the
"UN" unit of measurement.

Examples of drug products defined as "UN" Include but are not limited to:

Drug Name          NDC Code        NDC Billing Unit    Reported UoM

Adcetris 50 MG SOLR      51144-0050-01        UN             EA

Kyprolis 60 MG SOLR           76075-0101-01        UN              EA



• F2 (International Units) - used for measuring medications reported in International Units (e.g. antihemphilic factor)

• GR (Gram) - used to report a product measured by its weight. Commonly used in products supplied in ointment, cream, inhaler, or bulk powder in a jar. These are measured in as "GR" unit of measurement.

Examples of drug products defined as "GR" include but are not limited to:

Drug Name        NDC Code    NDC Billing Unit     Reported UoM

Morphine Sulfate POWD      00406-1521-53             GR              GM

Combivent Respimat 20-100        00597-0024-02          GR           GM
MCG/ACT AERS


• ML (Milliliter) - used to report a product measured by its liquid volume.

Examples of drug products defined as "ML" include but are not limited to:




Drug Name          NDC Code      NDC Billing Unit       Reported UoM

Simponi 50MG/0.5ML SOLN    57894-0070-01       ML        ML

Zaltrap 100MG/4ML SOLN    00024-5840-01        ML        ML


When coding a claim for an unclassified drug, the following NDC Quantity values are required NDC Quantity

• Unit of Measurement (UN, F2, ML, or GR)

Providers must be able to enter and transmit the required NDC fields on professional claims (electronic or CMS-1500) submitted to Florida Blue and receive information about those fields on error messages and remittance advices (electronic and/or paper). This may require technical updates to your claim submission and billing systems. Availity includes the required NDC fields on its input screens. If your practice management system does not accommodate this requirement, contact your vendor to coordinate changes.

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