In 2008, the Alabama Medicaid Agency (Medicaid) began requiring the NDC number for the top 20+ physician-administered multiple source drugs. Information on this requirement may be found in the July 2008 and April 2009 issues of the Provider Insider on the Agency’s website.

Effective October 1, 2010, the NDC number will be mandatory on ALLphysician-administered drugs in the following ranges: J0000 – J9999, S0000 – S9999, and Q0000 – Q9999. Physician-administered drugs include any covered outpatient drug billed either electronically or on paper CMS-1500 or UB-04 claim forms. NDC’s will be required on Medicare crossover claims for all applicable HCPCS codes on the list. The 11-digit NDC submitted must be the actual NDC number on the package or container from which the medicine was administered.

Medicaid will provide a grace period from August 15, 2010, to September 30, 2010, to allow providers sufficient time to acclimate to the change. During this grace period, Medicaid will validate the data and will set informational denial codes, but will NOTdeny the claim.

This requirement applies to:

• All fee-for-service providers who bill physician-administered drug codes

• HCPCS codes in the ranges J0000 – J9999, S0000 – S9999, and Q0000 – Q9999

• Both electronic and paper submissions

This requirement does NOTapply to:

• 340-B Providers enrolled on the HHS website

• Vaccines or other drugs in the CPT code ranges 01000 – 99999

• HCPCS that do not have an NDC

• HCPCS that are considered devices

• HCPCS that are considered radiopharmaceuticals

• Providers paid on a per diem, encounter, or other type of rate, which includes, but may not be limited to:

   - Inpatient Hospitals

   - Nursing Facilities

   - Federally Qualified Health Centers

   - Rural Health Centers

   - Ambulatory Surgical Centers

   - Home Health Agencies

As this  process is to facilitate Medicaid drug rebates from manufactures for physician-administered drugs, providers are required to utilize drugs manufactured by companies who hold a federal rebate agreement. These NDCs will be the only ones Medicaid will cover for payment. A list of those drug manufactures who hold a federal rebate agreement, as well as their labeler codes (the first 5 digits of the NDC number), are available on the Medicaid website at http://www.medicaid.alabama.gov/programs/pharmacy_svcs/resources_providers.aspx?tab=4

Select the Click Here link to access the list of covered labelers (manufacturers) available from CMS.

Providers are encouraged to begin providing the NDC for all physician-administered drugs immediately; however, it is not required until October 1, 2010. Refer to the Alabama Medicaid Provider Manual for billing instructions.

Questions should be directed to the Provider Assistance Center at 1-800-688-7989 for instate providers or (334) 215-0111 for out-of-state providers.