CurrentUnitedHealthcarePolicy 2025R6002A

NDC reporting requirements for professional and facility drug claims

Defines required NDC number, NDC unit of measure, and NDC units dispensed for reimbursement of professional (CMS-1500/837P) and facility (UB-04/837I) drug claims for UnitedHealthcare Medicare Advantage.

Policy Summary

PayerUnitedHealthcare

PolicyNDC reporting requirements for professional and facility drug claims

Policy CodePolicy 2025R6002A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSubmit a valid 11-digit NDC, the NDC unit of measure, and the NDC units dispensed on professional and facility claims; incomplete or invalid NDC information may result in claim denial.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

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

8/3digit limits for NDC units quantity

nationalpolicy scope

NDC Claim Submission Requirements

NDC claim submission criteria

Requirements for reimbursement of drug claims include precise NDC reporting and adherence to unit and packaging rules.

All of the following must be present on professional (CMS-1500/837P) and facility (UB-04/837I/837I) claims for reimbursement:

ALL of the following

Valid NDC number submitted as the actual NDC on the administered container in 11‑digit (5-4-2) format with leading zeros as needed.
NDC Unit of Measure (UOM) appropriate to the drug (e.g., ML, GR, UN, F2) must be reported.
NDC units dispensed: the actual decimal quantity administered must be reported using allowed digit limits and formatting rules.

ALL of the following

Policy Summary

PayerUnitedHealthcare

PolicyNDC reporting requirements for professional and facility drug claims

Policy CodePolicy 2025R6002A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionSubmit a valid 11-digit NDC, the NDC unit of measure, and the NDC units dispensed on professional and facility claims; incomplete or invalid NDC information may result in claim denial.

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 Formatting, Unit of Measure, and Quantity Rules

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

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

NDC must be submitted as the actual valid NDC on the container, in 11-digit 5-4-2 format without spaces or hyphens; add leading zeros when necessary.

NDC Unit of Measure (UOM)mixed

F2	International unit (used mainly when billing for Factor products).
GR	Gram (used for ointment, cream, inhaler, or bulk powder dispensed; primarily retail pharmacy).
ML	Milliliter (if a drug is supplied in a vial in liquid form, bill in milliliters).
UN	Unit (if a drug is supplied in a vial in powder form and must be reconstituted before administration, bill each vial/unit).

NDC Units Dispensed formatting rulesmixed

Quantity digit limits	Up to 8 digits before the decimal and up to 3 digits after the decimal; if entering a whole number, do not use a decimal; do not use commas; do not zero fill; report partial units using a decimal.
Examples	GR0.045; ML1.5; UN2.0; 1234.56; 2; 12345678.123.

Quantity digit limits and package maximums

Quantity digit limitsUp to 8 digits before the decimal and up to 3 digits after the decimal; if entering a whole number, do not use a decimal; do not use commas or zero-fill positions

Package maximumsUnits submitted must not exceed the package maximum units available based on the NDC number or increments associated with the drug package

Increment requirementUnits must be submitted in package increments; units not in package increments may be denied

Examples of valid formattingExamples: 1234.56, 2, 12345678.123 — use decimal point for partial units

Billing Requirements and Denial Risk

Denial Risk

NDC submission required — missing or invalid data may cause denial

Submit a valid NDC number, NDC unit of measure, and NDC units dispensed on professional (CMS-1500 / 837P) and facility (UB-04 / 837I) claims. The actual decimal quantity administered and the units of measurement are required; use a decimal point for partial units (e.g., ML1.5, UN2.0). Quantity format limits: up to eight digits before the decimal and up to three digits after the decimal; enter whole numbers without a decimal, do not use commas, and do not zero-fill. If the NDC is missing, invalid, or incomplete the claim may be denied; denied claims may be resubmitted with the appropriate NDC information for reconsideration.

Required on professional claims: valid NDC number, NDC unit of measure, NDC units dispensed (CMS-1500 / 837P).
Required on facility claims: valid NDC number, NDC unit of measure, NDC units dispensed (UB-04 / 837I).
Use decimal point for partial units (examples: GR0.045, ML1.5, UN2.0).
Quantity format: up to 8 digits before decimal and up to 3 digits after; whole numbers without a decimal; no commas; do not zero-fill.
Missing/invalid/incomplete NDC data may result in denial; resubmit denied claims with correct NDC information for reconsideration.

Key Terms

National Drug Code (NDC)

DefinitionNational Drug Code (NDC) — a unique industry standard numeric identifier assigned to medications that identifies manufacturer, drug name, dosage, strength, package size and quantity; the 11-digit NDC is in a 5-4-2 format

11-digit formatNDC is an 11-digit number separated into three segments in a 5-4-2 format; add leading zeros when necessary to achieve 5-4-2

Source on claimsThe NDC submitted must be the actual valid NDC number on the container from which the medication was administered and placed on the medical claim without spaces or hyphens

NDC Unit of Measure (UOM) examples and abbreviations

F2International unit (used mainly when billing for Factor preparations)

GRGram (used for ointment, cream, inhaler, or bulk powder dispensed)

MLMilliliter (if a drug is supplied in a vial in liquid form, bill in milliliters)

UNUnit (if a drug is supplied in a vial in powder form and must be reconstituted, bill each vial/unit used)