When billing unclassified drug codes (for example, J3490, J3590, J7199, J7599, etc.), the National Drug Code (NDC) is also required to identify the specific drug administered to the participant. DMBA uses NDC information to determine whether the drug meets the eligibility requirements of the participant’s medical plan.
Beginning September 1, 2018, DMBA will deny charges for unclassified drug codes that are billed without the NDC, and the claim will need to be resubmitted with the NDC to be considered for payment. To avoid claim denials, please make sure that unclassified drugs codes are properly billed with the appropriate NDC.
For more information and answers to frequently asked questions about billing with NDCs, click here.