CurrentUnitedHealthcarePolicy 2025R6002B

NDC reporting requirements for CMS-1500 and UB-04 drug claims

Defines UnitedHealthcare's requirements for submitting National Drug Code (NDC) information — including valid 11-digit NDC, unit of measure, and units dispensed — on professional and outpatient facility drug claims billed on CMS-1500, UB-04 or equivalent electronic transactions for Commercial and Individual Exchange plans.

Policy Summary

PayerUnitedHealthcare

PolicyNDC reporting requirements for CMS-1500 and UB-04 drug claims

Policy CodePolicy 2025R6002B

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit a valid 11-digit NDC plus NDC unit of measure and NDC units dispensed on claims; missing or mismatched NDC data may result in denial but can be resubmitted with correct information.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

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

8/3NDC units numeric limits

applies to allapplies to products

exemptimmunization exemption

presentattachments

Policy Summary

PayerUnitedHealthcare

PolicyNDC reporting requirements for CMS-1500 and UB-04 drug claims

Policy CodePolicy 2025R6002B

Change TypeNo material change

Effective Date

Next Review Date

Key ActionSubmit a valid 11-digit NDC plus NDC unit of measure and NDC units dispensed on claims; missing or mismatched NDC data may result in denial but can be resubmitted with correct information.

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.

NDC Submission Requirements for Reimbursement

NDC submission and billing criteria

Requirements for reimbursement of professional and outpatient facility drug claims:

A valid 11-digit NDC without spaces or hyphens must be submitted on the claim; if the label lacks 11 digits, add leading zeros to achieve the 5-4-2 format.

Valid NDC is required in addition to HCPCS/CPT/Revenue codes.

NDC unit of measure must be submitted and reflect the form administered (examples: ML, UN, GR, F2).

NDC units dispensed: report the actual decimal quantity administered using up to 8 digits before and 3 digits after the decimal; use a decimal for partial units and do not enter a decimal for whole numbers; do not use commas or zero-fill remaining positions.

Example: three 0.5 ml vials reported as ML1.5; valid examples include GR0.045, ML1.5, UN2.0.

NDC information is required in addition to HCPCS/CPT/Revenue codes; immunization drug codes are exempt from the NDC requirement.

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

Units submitted must not exceed the package maximum units associated with the NDC and must be submitted in package increments; units over the maximum or not in package increments will be denied.

Refer to Attachment for list of NDC numbers and maximum units.

The policy applies to claims reported on CMS-1500, 837 professional, UB-04, and 837i facility transactions for UnitedHealthcare Commercial and Individual Exchange plans.

When the container used to administer the medication differs from the exterior packaging (e.g., vial vs box), submit the NDC from the container actually used (use the vial NDC if different).

NDC and Related Coding Elements

NDC (11-digit 5-4-2)mixed

NDC (11-digit 5-4-2)

Valid 11-digit NDC must be submitted without spaces or hyphens; add leading zeros if needed to reach 5-4-2 format; use the NDC on the container actually used to administer the medication.

NDC UOM (ML, UN, GR, F2, ME)mixed

NDC UOM (ML, UN, GR, F2, ME)

Unit of measure codes: ML (milliliter), UN (unit), GR (gram), F2 (International unit), ME (valid but UN or ML recommended).

NDC units dispensedmixed

NDC units dispensed

Actual decimal quantity administered; up to 8 digits before and 3 digits after the decimal; use a decimal for partial units (e.g., ML1.5); do not zero-fill or use commas; if whole number do not include a decimal.

NDC units numeric limits

Numeric limitsMaximum 8 digits before the decimal and 3 digits after the decimal for NDC units dispensed.

Partial unitsUse a decimal for partial units (e.g., ML1.5 for three 0.5 mL vials).

Whole unitsIf entering a whole number, do not include a decimal (e.g., 2).

Formatting rulesDo not use commas or zero-fill; leave unused positions blank.

ExamplesValid examples: 1234.56 ; 2 ; 12345678.123

Billing Actions and Denial Risk

Denial Risk

NDC Submission and Denial Risk

Submit a valid 11-digit NDC, the NDC unit of measure, and the NDC units dispensed with professional and facility drug claims. Failure to provide NDC information that is missing, invalid, incomplete, or that does not match the submitted HCPCS, CPT, or Revenue code may result in claim denial. Denied claims can be resubmitted with the correct NDC information for reconsideration.

Required on CMS-1500, 837P, UB-04, and 837I: valid 11-digit NDC, NDC unit of measure, and NDC units dispensed
Report actual decimal quantity administered; use a decimal for partial units (e.g., ML1.5 for three 0.5 mL vials)
Quantity format limits: up to 8 digits before the decimal and up to 3 digits after (examples: 1234.56; 2; 12345678.123). If whole number, do not use a decimal. Do not use commas or zero-fill.
NDC requirement does not apply to child and adult immunization drug codes
When a medication is in a multi-vial package, use the NDC from the individual vial administered
NDC submission is required in addition to applicable HCPCS, CPT, or Revenue codes and their units; NDC units dispensed are separate from HCPCS/CPT/Revenue code units

Key Terms

NDC — National Drug Code (NDC)

TermNational Drug Code (NDC)

DefinitionA unique numeric identifier assigned to medications; identifies manufacturer, drug name, dosage, strength, package size and quantity.

FormatValid 11-digit NDC in 5-4-2 format submitted without spaces or hyphens; add leading zeros on label if necessary to create 5-4-2.

Container ruleSubmit the NDC from the container actually used to administer the medication (use vial NDC rather than exterior box NDC if different).

NDC unit of measure (UOM) codes and usage

Common UOM codesML (milliliter), UN (unit), GR (gram), F2 (international unit), ME (milliequivalent).

ML usageIf a drug is supplied in a vial in liquid form, bill in milliliters (ML).

UN usageIf a drug is supplied in a vial in powder form that must be reconstituted, bill each vial used as UN (unit/each).

GR usageGrams are usually used when an ointment, cream, inhaler, or bulk powder in a jar are dispensed (primarily retail pharmacy, not physician-administered billing).

F2 and ME guidanceF2 = International unit (mainly for Factor VIII); ME is valid but using UN or ML is recommended for pricing clarity.