CurrentColorado Rocky Mountain Health PlansPolicy 2026R6002B

NDC reporting requirements for CMS-1500 and UB04 drug claims

Defines required NDC number, unit of measure, and units dispensed information for professional (CMS-1500/837P) and facility (UB-04/837I) drug claims submitted to UnitedHealthcare Medicare Advantage; applies to providers submitting claims for Medicare Advantage products.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyNDC reporting requirements for CMS-1500 and UB04 drug claims

Policy CodePolicy 2026R6002B

Change TypeAdministrative updates (non-material)

Effective Date

Next Review Date

Key ActionSubmit accurate claims including a valid 11-digit NDC, appropriate unit of measure, and units dispensed along with applicable HCPCS/CPT codes.

SourceLink

POLICY UPDATE CHANGES

Table of Content section was added on 9/1/2025.

Policy list and history entries were updated on multiple dates (12/23/2025, 4/22/2026, etc.).

11-digitrequired NDC format

8/3max quantity digits

UB04 & CMS-1500forms covered

NDC + HCPCSidentifiers required

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NDC submission and denial criteria

Reimbursement requires submission of a valid NDC number, NDC unit of measure, and NDC units dispensed along with the applicable HCPCS/CPT code(s). Claims missing or containing invalid/incomplete NDC information or units that exceed package maximums may be denied.

ALL of the following

ALL of the following
- Valid 11-digit NDC from the container (identify the vial administered); pad with leading zeros to conform to 5-4-2 format if needed
  NDC must identify the vial that was administered (not necessarily the carton)
ALL of the following
- Use appropriate NDC UOM codes (examples: ML, UN, GR, F2) as defined in policy
ALL of the following
- Report the actual decimal quantity administered using decimals for partial units; do not use commas or zero-fill; if whole number, do not include a decimal<= 8 digits before decimal and <= 3 digits after decimal
ALL of the following
- Submit the applicable HCPCS or CPT code(s) and the number of HCPCS/CPT units in addition to the NDC details

Denial conditions

NDC is missing, invalid, or incomplete
If denied, claim may be resubmitted with appropriate NDC information for reconsideration
NDC units submitted exceed the package maximum units available for the NDC or are not submitted in allowed package increments

ALL of the following

When reporting partial units use a decimal point (examples: GR0.045, ML1.5, UN2.0); follow examples in policy
NDC information differentiates drugs that share the same HCPCS code and supports identification of billing errors and correct reimbursement processes

ALL of the following

Yes — a valid NDC must be submitted in addition to the applicable HCPCS/CPT code(s) and HCPCS/CPT units
NDC units dispensed are based on the numeric quantity administered and the NDC unit of measure and are distinct from HCPCS/CPT code units

Required Codes, Units & Formatting

Required identifiers for drug claimsmixedCovered

NDC (11-digit, 5-4-2)	Required NDC number from container; pad with leading zeros to achieve 11-digit 5-4-2 format
HCPCS/CPT	Applicable HCPCS or CPT code(s) must be submitted in addition to NDC

NDC units dispensed numeric limits

Allowed digits—integer portionUp to 8 digits before the decimal (maximum) — e.g., 12345678

Allowed digits—fractional portionUp to 3 digits after the decimal (maximum) — e.g., .123

Whole number entry ruleIf entering a whole number, do not use a decimal (e.g., use 2, not 2.0)

Formatting restrictionsDo not use commas and do not zero‑fill; leave unused positions blank

Examples1234.56; 2; 12345678.123

Provider Submission Responsibilities & Denial Risks

Billing Rule

Provider claim submission responsibilities

You are responsible for submitting accurate claims that include required NDC information and correct units of measure. This reimbursement policy uses standard coding guidelines (CPT, CMS, etc.) and applies to services billed on UB04 (CMS 1450) and CMS 1500 forms or their electronic equivalents. UnitedHealthcare Medicare Advantage reimbursement policies do not include prior authorization notations — confirm prior auth requirements through the member's benefit documents or plan resources. Ensure the claim(s) reflect the code(s) that correctly describe the services provided.

Submit complete NDC information on the claim for drugs (NDC number and NDC units dispensed).
Report the actual decimal quantity administered and the units of measurement; if reporting a partial unit, use a decimal (e.g., 0.5).
Quantity field supports up to 8 digits before the decimal and up to 3 digits after the decimal; do not use commas or zero-fill.
For whole numbers do not include a decimal point.
If a claim is denied for missing or invalid NDC data, resubmit with the appropriate NDC information for reconsideration.

Denial Risk

Denial risk for missing/invalid NDC or excess units

Missing, invalid, or incomplete NDC information or reporting units that exceed package maximums or are not in allowed package increments may result in claim denials. When units submitted exceed the package maximum units for the NDC (or are not submitted in package increments), the units over the maximum will be denied. If a claim is denied for NDC issues, it may be resubmitted with corrected NDC and unit information for reconsideration.

If the NDC is missing, invalid or incomplete the claim may be denied.
Units submitted should not exceed the package maximum units for the NDC; excess units will be denied.
Submit units in increments associated with the drug package; units not in allowed increments may be denied.

Key Terms

Definition of NDC (National Drug Code)

TermNational Drug Code (NDC)

DefinitionA unique numeric identifier assigned to medications under Section 510 of the Federal Food, Drug and Cosmetic Act; identifies manufacturer, drug name, dosage, strength, package size and quantity

Format requirement11‑digit NDC in 5-4-2 format (pad with leading zeros on the label segments as needed to achieve 5-4-2)

Claim requirementA valid NDC number from the container (without spaces or hyphens) must be submitted for reimbursement on CMS-1500 or UB-04 claims

NDC Unit of Measure (UOM) — examples

F2International unit — mainly used when billing for Factor preparations

GRGram — usually used for ointment, cream, inhaler, or bulk powder; primarily retail pharmacy

MLMilliliter — bill in milliliters for liquid vials

UNUnit — bill each vial (unit/each) when powder is reconstituted before administration

NDC Units Dispensed — quantity and formatting rules

What to reportThe actual decimal quantity administered (NDC Units Dispensed) must be reported on the claim

Partial unitsReport partial units using a decimal point (examples: GR0.045, ML1.5, UN2.0); if whole number, omit the decimal

Digit limitsMaximum of 8 digits before the decimal and 3 digits after the decimal

Formatting rulesDo not use commas; do not zero‑fill (leave remaining positions blank); whole numbers must not include a decimal point

ExamplesGR0.045; ML1.5; UN2.0; 1234.56; 2; 12345678.123

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyNDC reporting requirements for CMS-1500 and UB04 drug claims

Policy CodePolicy 2026R6002B

Change TypeAdministrative updates (non-material)

Effective Date

Next Review Date

Key ActionSubmit accurate claims including a valid 11-digit NDC, appropriate unit of measure, and units dispensed along with applicable HCPCS/CPT codes.

SourceLink

On This Page

OpenPayer

NDC reporting requirements for CMS-1500 and UB04 drug claims

NDC Submission & Denial Rules

Required Codes, Units & Formatting

Provider Submission Responsibilities & Denial Risks

Key Terms