ModifiedHighmark Blueshield NenyPolicy N/A

Highmark List of Procedure Codes Requiring NDC

A payer list of J- and other procedure (HCPC) codes for which an NDC will be required for claims processing effective April 1, 2026; applies to providers submitting claims to Highmark BlueShield NE/NY.

Policy Summary

PayerHighmark Blueshield Neny

PolicyList of Procedure Codes Requiring NDC

Policy CodePolicy N/A

Change TypeAdded list of procedure codes requiring NDC

Effective DateApr 1, 2026

Next Review Date

Key ActionProviders must submit NDC information on claims for the listed procedure codes effective 4/01/2026.

SourceLink

POLICY UPDATE CHANGES

A list of procedure codes requiring NDC submission was published effective 4/01/2026.

A large set of J-codes (HCPCS procedure codes) are listed as requiring NDC effective 4/01/2026.

100+procedure codes listed (excerpt)

~220+J‑codes in excerpt

4/01/2026Requirement start

Includes J3490/J3590Unclassified codes present

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 Reporting — Affected Procedure Codes

NDC reporting list (operational/billing requirement)

This document enumerates procedure codes that will require NDC reporting; it does not in this partial excerpt specify coverage denial criteria or clinical coverage rules.

Providers must submit NDC information on claims for the procedure codes listed in this document effective 4/01/2026.

NDC reporting requirement — code list (partial)

Codes listed below require NDC reporting when billed to Highmark BlueShield of NENY effective 4/01/2026.

The following HCPCS J-codes require NDC submission when billed to Highmark BlueShield NENY: e.g., J1459, J1460, J1551, J1552, J1553, J1554, J1555, J1556, J1557, J1558, J1559, J1561, J1566, J1568, J1569 (and additional immune globulin and related J-codes listed in the policy).

NDC reporting list (partial)

This section lists procedure codes for which NDC reporting will be required; it does not state payment or coverage determination beyond the reporting requirement.

A broad set of HCPCS/J-codes and other procedure codes require NDC submission when billed to Highmark, including (but not limited to) gene therapy, biologic, oncology and infusion-related J-codes such as J3396, J3397, J3398, J3401, J3424, J3465, J3471, J3485, J3490, J3590, J7030, J7168, J7170, J9264, J9271, J9280, J9286, J9289, J9292, J9301, J9310 (see full list in policy).

NDC submission requirement

The document enumerates procedure codes for which NDC submission is required when billing Highmark BlueShield NENY beginning 4/01/2026.

Providers must include the National Drug Code (NDC) on claims for the listed procedure codes (including J-, Q- and other specified HCPCS codes such as Q0138, Q0139, Q0155, Q0166, Q0167) effective 4/01/2026.

Code Examples — Samples from the Required NDC List

Examples from the required-NDC code listmixed

90378	RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL ANTIBODY, RECOMBINANT, FOR INTRAMUSCULAR USE, 50 MG, EACH.
C9399	UNCLASSIFIED DRUGS OR BIOLOGICALS.
J0121	INJECTION, OMADACYCLINE, 1 MG.

Sample of J‑codes requiring NDCHCPCS

J1459	INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G.LIQUID), 500 MG.
J1551	INJECTION, IMMUNE GLOBULIN (CUTAQUIG), 100 MG.
J1595	INJECTION, GLATIRAMER ACETATE, 20 MG.
J2405	INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
J2505	INJECTION, PEGFILGRASTIM, 6 MG
J3490	UNCLASSIFIED DRUGS
J3590	UNCLASSIFIED BIOLOGICS
J7030	INFUSION, NORMAL SALINE SOLUTION, 1000 CC

Sample of listed HCPCS/J-codes requiring NDCHCPCS

J3396	INJECTION, VERTEPORFIN, 0.1 MG
J3471	INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1 USP UNIT
J3490	UNCLASSIFIED DRUGS
J3590	UNCLASSIFIED BIOLOGICS
J7030	INFUSION, NORMAL SALINE SOLUTION , 1000 CC
J7312	INJECTION, DEXAMETHASONE, INTRAVITREAL IMPLANT, 0.1 MG
J7500	AZATHIOPRINE, ORAL, 50 MG
J9000	DOXORUBICIN HCL, 10 MG
J9171	INJECTION, DOCETAXEL, 1 MG
J9204	INJECTION, MOGAMULIZUMAB-KPKC, 1 MG

1–10 of 12

1/2

Examples of J-codes requiring NDCHCPCSCovered

J9264	OXALIPLATIN, 0.5 MG.
J9271	INJECTION, PEMBROLIZUMAB, 1 MG.
J9305	INJECTION, PEMETREXED, 10 MG (NOT OTHERWISE SPECIFIED)

Examples of Q-codes and CAR-T codes requiring NDCHCPCSCovered

Q0138	FERUMOXYTOL, 1 MG (non-ESRD use)
Q0220	TIXAGEVIMAB AND CILGAVIMAB (pre-exposure prophylaxis)
Q2042	TISAGENLECLEUCEL, CAR-T per therapeutic dose

What Providers Must Do

Billing Rule

NDC submission required

Submit the National Drug Code (NDC) when billing the following procedure codes. Failure to report NDC may result in claim processing delays or denials.

Applicable effective date: 2026-04-01
Include NDC on all professional and facility claims where an NDC is required

Note

NDC requirement — code list (partial)

The following is a partial listing of procedure codes that require NDC reporting. This list is not exhaustive; report NDC for any drug/biological billed with an NDC-eligible HCPCS/CPT/J-code per payer requirements.

90378
C9399
J0121

Terms and Scope

Procedure codes requiring NDC

DefinitionList of procedure/HCPC codes for which NDC is required on claims to Highmark BlueShield NENY.

Effective dateEffective 4/01/2026.

Examples (selected)90378 (RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL ANTIBODY), C9399 (UNCLASSIFIED DRUGS OR BIOLOGICALS), J0121 (OMADACYCLINE, 1 MG).

HCPCS J‑code

TermHCPCS J‑code — the procedure/drug billing codes listed in this document for which NDC will be required.

ScopeApplies to the J‑codes listed when billed to Highmark BlueShield NENY.

Examples (selected)

Policy Summary

PayerHighmark Blueshield Neny

PolicyList of Procedure Codes Requiring NDC

Policy CodePolicy N/A

Change TypeAdded list of procedure codes requiring NDC

Effective DateApr 1, 2026

Next Review Date

Key ActionProviders must submit NDC information on claims for the listed procedure codes effective 4/01/2026.

SourceLink

On This Page

Documentation Required

NDC reporting requirement — what to include

When submitting NDCs, include the following for each applicable line item: the 11-digit NDC (zero-padded as needed), unit of measure (UOM), quantity, and basis of measurement per claim form guidelines. Ensure NDCs correspond to the billed drug/biologic and match supporting documentation.

11-digit, zero‑padded NDC (format: 5-4-2 or 5-3-2 rendered as 11 digits)
Unit of measure (e.g., F2 = International Unit, ML = milliliter)
Quantity and basis of measurement per CMS/claim form guidance
NDC must match the administered product on medical record

Billing Rule

NDC requirement for listed procedure codes

For the procedure codes listed above, report the NDC on the claim line. Examples of affected codes include but are not limited to those shown in the partial lists; check payer coding guidance for additional codes and updates.

Report NDC on each claim line for codes listed in the partial code lists above
Verify NDC accuracy against the manufacturer’s label and the patient’s medical record
Retain product documentation (e.g., vial label, administration record) in the patient chart for audit

J1459 (IMMUNE GLOBULIN, PRIVIGEN, IV, 500 MG), J1551 (IMMUNE GLOBULIN, CUTAQUIG, 100 MG), J1561 (GAMUNEX-C/GAMMAKED, 500 MG).

J-code NDC requirement

RequirementHCPCS J‑codes listed require submission of NDC information on claims to Highmark effective 4/01/2026.

RationaleOperational billing requirement to capture NDC for listed J‑codes (includes gene therapies, biologics, and specialty injectables).

Examples (selected)J3396 (VERTEPORFIN, 0.1 MG), J3424 (HYDROXOCOBALAMIN, IV, 25 MG), J3471 (HYALURONIDASE, OVINE), among others.

Procedure codes requiring NDC

DefinitionProcedure/HCPCS codes for which NDC submission is required when billing Highmark BlueShield NENY.

Effective dateRequirement effective 4/01/2026 for the codes listed in the document.

Examples (selected)J9264 (PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG), J9271 (PEMBROLIZUMAB, 1 MG), J9280 (MITOMYCIN, 5 MG).