Dec. 30, 2019

BlueCross BlueShield South Carolina and BlueChoice^® HealthPlan require providers to file a valid NDC with the unit of measure and quantity for all professional and outpatient administered drug lines. If the NDC is missing, incomplete, invalid or doesn’t match the CPT code submitted, the charges on the claim may not be processed for payment.  

The NDC to be used is located on the actual package of the dosage being administered to the patient, not the NDC that comes on the box of products. For instance, a box of drugs may contain ten vials and each of the vials will have an NDC on it. The NDC on the vial is what should be reported with the CPT code.

Submitted NDCs must have 11 digits following the 5-4-2 format. If the package lists an NDC with 10 digits, it must be converted to an 11-digit NDC. To do this, first determine the format of your 10-digit NDC by closely examining the package information and counting the numbers separated by dashes.  Once you have identified the format as either 4-4-2, 5-3-2 or 5-4-1, insert a zero according to the table below:

Keep in mind that NDCs can change. For this reason, it is imperative that your systems are always up to date to include the most recent NDC. This will ensure that the correct NDC is being submitted along with the CPT code filed.

BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association.