CurrentBlue Cross Blue Shield - New MexicoPolicy N/A

Select Medication List (NDC-based reimbursement)

Defines BCBSNM's Select Medication List program where submitting specific National Drug Codes (NDCs) with claims yields higher reimbursement for certain medications; applies to providers submitting professional/ancillary (ANSI 837P) and CMS-1500 claims to Blue Cross and Blue Shield of New Mexico.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicySelect Medication List (NDC-based reimbursement)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionInclude National Drug Code (NDC) data on professional (ANSI 837P) and CMS-1500 claims to avoid claim return and enable reimbursement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2medications on list

monthlyreimbursement update

requiredNDC requirement

Select Medication List Reimbursement Criteria

Select Medication List reimbursement criteria

Reimbursement rules and scope for Select Medication List items:

Claims for drugs submitted on professional (ANSI 837P) and CMS-1500 forms must include National Drug Code (NDC) data or the claim will be returned.

When billed with the appropriate NDC, medications listed on the Select Medication List will receive a higher reimbursement rate than non-listed drugs in the same class.

Reimbursement for specialty pharmacy drugs, including those on the Select Medication List, is updated monthly.

Currently includes Orthovisc and Synvisc-One (viscosupplementation injections for osteoarthritis knee pain). Additional medications will be added in stages; timelines have not been finalized.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicySelect Medication List (NDC-based reimbursement)

Policy CodePolicy N/A

Change TypeNo material change

Effective DateN/A

Next Review DateN/A

Key ActionInclude National Drug Code (NDC) data on professional (ANSI 837P) and CMS-1500 claims to avoid claim return and enable reimbursement.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Provider Billing Requirements and Reimbursement Impact

Billing Rule

NDC Requirement for Claim Acceptance

Professional/ancillary electronic (ANSI 837P) and paper (CMS-1500) claims for drugs must include National Drug Code (NDC) data to be accepted for processing by Blue Cross and Blue Shield of New Mexico (BCBSNM). If NDC data isn't included as required by BCBSNM, your claim will be returned to you. Filing NDCs, in conjunction with the appropriate Healthcare Common Procedure Coding System (HCPCS) and/or Current Procedural Terminology (CPT) information, enables BCBSNM to reimburse you, in most instances, for the individual medication that was prescribed (instead of for a range of NDCs within HCPCS/CPT codes).

Applicable claim formats: ANSI 837P (electronic professional) and CMS-1500 (paper)
Include complete NDC data on the claim line when billing a drug
If NDC is missing or incomplete the claim will be returned

Billing Rule

Increased Reimbursement for Select Medication List Items

BCBSNM maintains a Select Medication List. Choosing a medication from the Select Medication List and billing it with the appropriate NDC will result in a higher reimbursement rate than the rate applied to other, non-listed drugs in the same class. Reimbursement for specialty pharmacy drugs, including those on the Select Medication List, is updated monthly as applicable. Increased reimbursement is limited to medications appearing on the Select Medication List.

Currently listed medications (examples): Orthovisc® (viscosupplementation injection for osteoarthritis knee pain), Synvisc-One® (viscosupplementation injection for osteoarthritis knee pain)
Billing requirement: must submit the specific NDC for the listed medication to receive increased reimbursement
BCBSNM will add medications to the Select Medication List over time; updates will be announced in News and Updates and may appear in Blue Review

Key Definitions

Select Medication List — definition

DefinitionSelect Medication List: a staged list of specific drugs within classes chosen based on safety and cost-effectiveness; drugs on the list billed with the appropriate NDC receive higher reimbursement than non-listed drugs in the same class.

Current contentsIncludes specific viscosupplementation injections such as Orthovisc and Synvisc-One (additional medications to be added in stages)

PurposeSupports NDC pricing initiatives to reimburse for the individual medication prescribed when billed with appropriate NDC and HCPCS/CPT information

LimitationListing of a drug is not a guarantee of benefits; payment remains subject to member eligibility, policy terms, limitations and exclusions

National Drug Code (NDC) — claim requirement

DefinitionNational Drug Code (NDC): the numeric drug identifier required by BCBSNM on professional/ancillary electronic (ANSI 837P) and paper (CMS-1500) claims for drug processing.

Claim requirementProfessional (ANSI 837P) and CMS-1500 claims for drugs must include NDC data or the claim will be returned to the provider.

Use with codingNDC must be filed in conjunction with appropriate HCPCS and/or CPT information to enable reimbursement for the individual medication.

OpenPayer

Select Medication List (NDC-based reimbursement)

Select Medication List Reimbursement Criteria

Coding and Update Frequency

Provider Billing Requirements and Reimbursement Impact

Key Definitions