Highmark List of Procedure Codes Requiring NDC
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This document lists HCPCS/CPT/J-codes and related procedure codes for which National Drug Code (NDC) reporting will be required effective 10/01/2025 and applies to Highmark Blueshield Neny claim submissions.
A list of procedure codes requiring NDC reporting effective 10/01/2025 is provided.
A large list of specific J- and Q- codes (HCPCS) are designated as requiring NDC reporting effective 10/01/2025.
Coverage / Billing Criteria
Billing requirement with no clinical coverage criteria in this section — lists procedure codes requiring NDC but no medical necessity criteria
Billing requirement: The following procedure codes require National Drug Code (NDC) information to be submitted on claims when billed to Highmark Blueshield Neny effective 2025-10-01. This is an operational billing requirement only and does not convey clinical coverage or medical necessity criteria.
Codes requiring NDC
Affected Procedure Codes & Effective Date
Provider Billing Actions Required
NDC Submission Required
Providers must submit the National Drug Code (NDC) on claims for the procedure codes listed by Highmark below. This requirement applies to claims with dates of service on or after 2025-10-01. Failure to include the appropriate NDC may result in claim rejection or delay in payment.
- Effective date: 2025-10-01
- Requirement: Submit NDC on the claim for each applicable line item
NDC Reporting Requirement
For the procedure codes listed by Highmark, providers must report the corresponding NDC value on all submitted claims (professional and facility). Ensure the NDC is formatted and placed in the NDC field per payer/billing system specifications and that units and quantity align with the billed HCPCS/J-code.
- Applies to: All providers billing the listed procedure codes
- Claims affected: Professional (CMS-1500/837P) and Institutional (UB-04/837I) claims
Highmark Procedure Codes Requiring NDC
Highmark’s list of procedure codes requiring NDC submission (effective 10/01/2025) includes, but may not be limited to, the following HCPCS/CPT/J/Q codes. Providers must include the NDC for these codes when filing claims on or after the effective date: 90378, J1443, J2407, J0690, J0692, J0696, J2260, J2405, J3370, J7030, J0202, J0565, J0604, J0606, J0640, J0725, J0887, J0888, J1428, J1460, J9312, Q2042, Q5105, Q5106, Q5107, Q5109, Q9991, Q9992, J0179, J9309, J9199, J0693, J1823, J7212, J7352, J7321, J0224, J1951, J7168, J9348, J9353, Q5123, J0138, J0175, J1171, J1749, J2002, J2003, J2004, J2252, J2253, J2601, J8522, J8541, J1650, J1652, J1670, J1700, J1720, J1726, J1729, J1740, J1741, J1742, J1743, J1744, J1745, J1750, J1756, J1786, J1790, J1800, J1815, J1817, J1826.
- List type: Highmark procedure codes requiring NDC
- Effective date: 2025-10-01
- Action: Include NDC and units on claim line for each listed code
Operational Guidance and Documentation
Operational notes: 1) If a billed code is on the Highmark list, include the product NDC (11-digit) and unit quantity corresponding to the paid amount. 2) For combination products or biosimilars, submit the specific product NDC actually administered. 3) Maintain documentation linking the NDC to the administered drug in the medical record in case of audit. 4) For questions about code applicability or NDC placement, contact Highmark provider services.
- NDC format: 11-digit (NPI-compatible billing systems may require zero-padding)
- Documentation: Retain records tying NDC to administration for audit
Definitions & Scope
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