Highmark List of Procedure Codes Requiring NDC
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A payer list of HCPCS/J-codes and other procedure codes for which submission of National Drug Code (NDC) information will be required beginning 1/01/2026; affects providers billing these codes to Highmark BlueShield of NENY.
Multiple J-codes (HCPCS) are designated as requiring NDC effective 1/01/2026.
A comprehensive list of J‑ and related HCPC procedure codes that will require NDC reporting was provided effective 1/01/2026.
Procedure codes that require NDC submission
NDC submission requirement (code list)
This file is a code list indicating which procedure codes will require an associated NDC when billed.
NDC submission criteria (billing requirement)
Providers must include the NDC when billing the following HCPCS J‑codes (partial excerpt).
NDC submission criteria for listed codes
When submitting claims for any procedure codes enumerated below, providers must include the corresponding NDC on the claim.
ALL of the following
NDC submission requirement
Billing requirement: when billing for these procedure codes, providers must include the NDC for the drug product.
ALL of the following
Representative codes requiring NDC
- J7516 – Injection, cyclosporine, 250 mg
- J7311 – Injection, fluocinolone acetonide, intravitreal implant (Retisert), 0.01 mg
- Q0235 – Injection, monoclonal antibody products for COVID-19 (examples include post-exposure prophylaxis or treatment)
- Q0237 – Injection, tocilizumab, for hospitalized adult patients with COVID-19
NDC submission requirement — code list
Codes listed in this document require submission of associated NDCs when billed to Highmark BlueShield NENY.
ALL of the following
Selected Q-/biosimilar/S-code examples
Example and representative HCPCS / J / Q / S codes
| 90378 | RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL ANTIBODY, RECOMBINANT, FOR INTRAMUSCULAR USE, 50 MG, EACH. |
| C9399 | UNCLASSIFIED DRUGS OR BIOLOGICALS |
| J0121 | INJECTION, OMADACYCLINE, 1 MG |
| J0122 | INJECTION, ERAVACYCLINE, 1 MG |
| J0135 | INJECTION, ADALIMUMAB, 20 MG |
| J0218 | INJECTION, OLIPUDASE ALFA-RPCP, 1 MG |
| J0248 | INJECTION, REMDESIVIR, 1 MG |
| J0570 | Buprenorphine implant, 74.2 mg |
| J0738 | Injection, lenacapavir, 1 mg, fda approved prescription, only for use as hiv pre-exposure prophylaxis |
| J2505 | INJECTION, PEGFILGRASTIM, 6 MG |
| J2543 | INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM/0.125 GRAMS (1.125 GRAMS) |
| Q0235 | Injection, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, not otherwise classified, 1 mg. |
| Q0237 | Injection, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg |
| Q0239 | INJECTION, BAMLANIVIMAB-XXXX, 700 MG |
| Q0240 | INJECTION, CASIRIVIMAB AND IMDEVIMAB, 600 MG |
What providers must do
NDC required on claims for listed procedure codes effective 01/01/2026
Effective 01/01/2026, providers billing any of the procedure codes enumerated in this document must include the associated National Drug Code (NDC) on the claim.
Include NDC for listed J-codes starting 01/01/2026
Providers must include the NDC when submitting claims for the listed J‑/HCPCS procedure codes beginning 01/01/2026.
Scope: injectables, infusions, implants and other drug administration codes
The operational scope requires reporting the NDC on claims for injectable, infusion, implant, and other drug administration procedure codes included in the list when billed to the payer.
Submit NDC when billing listed HCPCS/J- and Q-codes
When billing any of the HCPCS/J- and Q-codes listed in this document, providers must submit the applicable NDC for the drug product on the claim.
Biosimilar HCPCS/Q-codes require NDC
An extensive set of biosimilar Q‑series codes (Q5103–Q5130 and beyond) are included in the list and require submission of the NDC when billed.
Other included drug codes (Q99xx, S-series, S555x) require NDC
Additional drug-related codes such as Q99xx entries, S‑series procedure codes, and S555x insulin codes are included and require associated NDC submission.
- Examples include Q9991–Q9999 entries, S0013 (esketamine nasal spray), and insulin codes S5550–S5553.
- When billing these codes, include the NDC for the administered product.
Definitions and key terms
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