CurrentColorado Rocky Mountain Health PlansPolicy N/A

National Drug Code (NDC) requirements for claims

Defines required NDC data (11-digit NDC, unit of measure, units dispensed) for professional and outpatient facility claims submitted to UnitedHealthcare Community Plan; applies to Medicaid and Medicare products and providers submitting CMS-1500/UB-04/837 transactions.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyNational Drug Code (NDC) requirements for claims

Policy CodePolicy N/A

Change TypeRevisions to reimbursement guidelines and state exceptions

Effective DateN/A

Next Review DateN/A

Key ActionSubmit a valid 11-digit NDC, NDC unit of measure, and NDC units dispensed on claims; missing or invalid NDC data may cause claim denial but can be resubmitted for reconsideration.

SourceLink

POLICY UPDATE CHANGES

Reimbursement Guidelines updated.

Attachments list of NDC numbers for packaged drugs with maximum units updated.

State exceptions updated multiple times (removals/updates across dates in 2025 and 2024).

11-digitrequired NDC format (5-4-2)

3required NDC data elements

8+3quantity digit limits

Listed

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.

NDC Submission & Reimbursement Criteria

NDC submission and reimbursement criteria

Reimbursement is conditioned on correct submission of NDC data alongside procedure/drug codes; specific formatting, unit-of-measure and quantity rules apply. Exceptions and package limits are noted.

ALL of the following

A valid 11-digit NDC in 5-4-2 format must be submitted without spaces or hyphens and must match the container NDC from which the medication was administered (use interior/container NDC when present).
An NDC Unit of Measure (UOM) must be submitted (examples: ML, UN, GR, F2; ME is valid but UN or ML recommended per unit guidance).
NDC Units Dispensed (the actual decimal quantity administered) must be reported; use a decimal for partial units and adhere to digit limits (up to 8 digits before the decimal and up to 3 digits after the decimal).

ALL of the following

If the NDC on the label does not show 11 digits, add a leading zero to the appropriate segment to create a 5-4-2 configuration. Submit the numeric NDC without spaces or hyphens.
For partial units, report using a decimal (examples: ML1.5, GR0.045, UN2.0). When entering a whole number, do not include a decimal. Do not use commas or zero-fill; leave remaining positions blank.
NDC information must be submitted in addition to the applicable HCPCS, CPT, or Revenue code(s) and the corresponding code units on the claim.

ALL of the following

Units submitted should not exceed the package maximum units available based on the NDC; units must be submitted in package increments where applicable.
When units submitted exceed the maximum units allowed per package or are not in increments of the package, units exceeding the maximum will be denied. See the Attachment for the list of NDC numbers and maximum units.

Exceptions and denial policy

The NDC requirement does not apply to child and adult immunization drug codes.
If NDC information is missing, invalid, incomplete, or does not match the HCPCS or CPT submitted, the claim may be denied; denied claims may be resubmitted with appropriate NDC information for reconsideration of reimbursement.

Operational note

Use the NDC from the individual vial/container that was administered (not the external box) when both interior and exterior packaging provide different NDCs.

Codes, Formats, and Quantity Rules

NDC and associated data elementsmixedCovered

NDC (11-digit, 5-4-2)	Required numeric identifier for drugs; must be submitted without spaces or hyphens and reflect the container NDC (11-digit in 5-4-2 format).
UOM (ML, UN, GR, F2, ME)	NDC Unit of Measure codes (examples: ML, UN, GR, F2, ME); units of measurement are required on the claim and partial units are reported using decimals.

Exceptionsmixed

Exceptions: immunizations

NDC requirement does not apply to child and adult immunization drug codes.

Quantity digit limits

Quantity digit limitsUp to 8 digits before the decimal and up to 3 digits after the decimal; if entering a whole number, do not use a decimal; do not use commas or zero-fill — leave remaining positions blank.

Examples — valid formats1234.56; 2; 12345678.123

Partial unitsReport partial units using a decimal (e.g., ML1.5 for three 0.5 ml vials reported as 1.5 mL).

Submission Requirements and Denial Risks

Denial Risk

Claim may be denied for missing/invalid NDC

If NDC information is missing, invalid, incomplete, or does not match the HCPCS or CPT submitted, the claim may be denied; denied claims can be resubmitted with the appropriate NDC information for reconsideration.

Billing Rule

NDC, UOM and units dispensed required on claims

A valid 11-digit NDC, the NDC unit of measure, and the NDC units dispensed (actual decimal quantity administered) are required on professional and facility claims submitted on the CMS-1500/837P and UB-04/837I for reimbursement.

Submit the 11-digit NDC in 5-4-2 format without spaces or hyphens and reflecting the container NDC.
Report NDC units dispensed using decimals for partial units and adhere to digit limits (up to 8 digits before and up to 3 digits after the decimal).

NDC Terminology and Units

NDC (National Drug Code)

DefinitionNational Drug Code (NDC) — an 11-digit unique numeric identifier in a 5-4-2 format assigned to medications; identifies manufacturer (first 5 digits), product and package size (remaining 6 digits).

Formatting guidanceSubmit the 11-digit NDC without spaces or hyphens; if label omits a leading zero, add it to create the 5-4-2 configuration.

Container-specific requirementThe NDC submitted must be the actual valid NDC on the container from which the medication was administered (interior container NDC if present).

NDC Unit of Measure (UOM)

Typical UOM codesML (milliliter), UN (unit/each), GR (gram), F2 (international unit).

Guidance — MLUse ML when a drug is supplied in a vial in liquid form; bill in milliliters.