CurrentPremera BluecrossPolicy cmi_171628

National Drug Code (NDC) Billing Guidelines - Professional Claims

Governs submission and billing requirements for National Drug Code (NDC) numbers, units, and related HCPCS procedure codes on professional (CMS-1500 / ANSI 837P) claims for Premera Blue Cross and affiliated lines of business.

Policy Summary

PayerPremera Bluecross

PolicyNational Drug Code (NDC) Billing Guidelines - Professional Claims

Policy CodePolicy cmi_171628

Change TypeAdded operational guidanceclarifications and revisions

Effective DateOriginal Effective Date

Next Review Date

Key ActionSubmit an active 11-digit NDC plus unit/basis (UN, ML, GR, F2) and NDC units on the same professional claim line as the HCPCS code.

SourceLink

POLICY UPDATE CHANGES

Created a new section titled Discarded, Wasted and Non-Administered Drugs with instructions on coding single-use vial/package wastage using separate claim lines and JW/JZ modifiers.

Removed all references to 'ME-Milligrams' and added clarifications for how to submit NDCs and paper claim formatting.

Clarified that any radiopharmaceutical, supply or device with an assigned NDC must be submitted with NDC, units/basis of measurement, and an appropriate HCPCS code.

11-digitRequired NDC format on claims

UN, ML, GR, F2Accepted unit qualifiers

JW/JZWaste modifiers

CMS-1500/837PClaim forms governed

Coverage and Billing Requirements

Coverage and billing requirements

Billing and reimbursement are contingent on correct submission of NDC and HCPCS information; failure to comply may result in denial.

An active/valid 11-digit NDC (5-4-2 format) must be submitted on the same professional claim line as the applicable HCPCS procedure code.

If the NDC on the package is fewer than 11 digits or contains an asterisk as a placeholder for leading zeros, the submitted claim must include leading zeros to complete the 11-digit NDC.

An NDC unit/basis of measurement (e.g., UN, ML, GR, F2) and the NDC units (quantity) must be submitted on the same claim line as the HCPCS procedure code.

When billing compounded drugs, each component drug must be billed on a separate claim line with its own HCPCS procedure code, product ID qualifier, NDC number, unit/basis of measurement, and NDC units.

Policy Summary

PayerPremera Bluecross

PolicyNational Drug Code (NDC) Billing Guidelines - Professional Claims

Policy CodePolicy cmi_171628

Change TypeAdded operational guidanceclarifications and revisions

Effective DateOriginal Effective Date

Next Review Date

Key ActionSubmit an active 11-digit NDC plus unit/basis (UN, ML, GR, F2) and NDC units on the same professional claim line as the HCPCS code.

SourceLink

On This Page

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.

Claim-level Coding, Modifiers, and Formatting

Claim-level qualifiersmixedCovered

N4	Product ID qualifier for NDC in ANSI 837P / CMS-1500 shaded field

Modifiers - wastage reportingModifierCovered

JW	Modifier - Drug amount discarded/not administered to any patient (used on HCPCS code for wasted single-use vial amount)
JZ	Modifier - Zero amount discarded/not administered to any patient

Other claim-level codesmixedCovered

National Unit Count

Field used to enter the quantity (number of NDC Units) in ANSI 837P loop 2410

Unit/basis qualifiersmixed

UN	Unit (NDC unit/basis of measurement)
ML	Milliliter (NDC unit/basis of measurement)
GR	Gram (NDC unit/basis of measurement)
F2	International Unit (NDC unit/basis of measurement)

NDC unit quantity formatting (CMS-1500 shaded field)

Allowed digits before decimal (administered or wasted)Up to eight digits before the decimal for NDC unit quantities on the CMS-1500 shaded field (Field 24).

Allowed digits after decimalUp to three digits after the decimal for NDC unit quantities on the CMS-1500 shaded field.

Whole number entry ruleIf entering a whole number, do not include a decimal or comma and do not zero-fill; leave remaining positions blank.

One NDC per HCPCS on CMS-1500CMS-1500 allows submission of one NDC number per HCPCS procedure code on the claim line; include unit quantity in shaded field.

Submission Requirements and Provider Billing Actions

Documentation Required

NDC must be submitted with HCPCS on same claim line

Submit an active/valid 11-digit NDC, the NDC unit/basis of measurement (UN, ML, GR, F2), and the NDC units on the same professional claim line as the applicable HCPCS procedure code. On CMS-1500, enter qualifier N4, one space, the 11-digit NDC (include leading zeros), then the unit qualifier (UN, ML, GR, or F2) and the NDC quantity in the shaded/upper portion of Field 24 while the HCPCS procedure code is billed in the unshaded/lower portion of the same line.

Billing Rule

Report single‑use vial wastage with separate claim lines and JW/JZ

For single-use vial/package wastage submit two separate claim lines: one for the administered portion and a second for the discarded/wasted portion. Append modifier JW to the HCPCS code on the wasted line and append modifier JZ to the HCPCS code when zero amount was discarded; document the number of units administered and discarded in the patient medical record.

Administered portion: N4 qualifier, 11-digit NDC, unit qualifier (UN, ML, GR, F2), quantity administered (up to eight digits before decimal and up to three after) in shaded Field 24; HCPCS with NO modifier in unshaded portion.
Wasted portion: N4 qualifier, 11-digit NDC, unit qualifier, quantity wasted (up to eight digits before decimal and up to three after) in shaded Field 24; same HCPCS appended with modifier JW.
If no wastage, append modifier JZ to HCPCS on the administered line to indicate zero amount discarded.

Key Definitions

NDC — definition and claim formatting

DefinitionNational Drug Code (NDC): An 11-digit number in a 5-4-2 format (NNNNN-NNNN-NN) assigned by the FDA; segments identify labeler, product, and package.

Required format on claimsSubmit as an 11-digit number with no spaces, including leading zeros (fill any missing digits with zeros).

Paper claim placementOn CMS-1500, enter qualifier N4, one space, then the 11-digit NDC in the shaded/upper portion of Field 24 followed by unit qualifier and quantity.

Electronic claim qualifierUse product ID qualifier N4 for NDC submission in ANSI 837P electronic claims (ID loop 2410).

Compound / Compounded drugs — billing requirements

Compound billing requirementEach specific drug ingredient in a compound must be billed on a separate claim line with its appropriate HCPCS drug procedure code.

NDC details per componentFor each component, include the product ID qualifier, the 11-digit NDC number, unit/basis of measurement, and NDC units on the same line.

Consequence of omissionFailure to include an NDC number in the required format with the billed HCPCS procedure code will result in denial of reimbursement.