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Updated List of Drugs Requiring NDC for Reimbursement

Information posted December 18, 2009

Effective for dates of services on or after February 1, 2010, procedure codes J1566, J0207 and J1040 must be submitted with an 11-digit National Drug Code (NDC). If these procedure codes are submitted on a claim without the NDC number, the claim will be denied, even if it was prior authorized. Click on the title to view an updated list of procedure codes that require the NDC number on claims. The NDC number that is submitted to Texas Medicaid or the Children with Special Health Care Needs (CSHCN) Services Program must be the NDC number on the package or container from which the medication was administered. The following table shows the procedure codes that must be submitted with an NDC number:

Procedure Codes J0640 J1631 J1260 J9217 J2405 J9293 J9390 J2430 J9045 J0696 J1626 J9190 J7190 J9000 J2550 J9265 J9178 J9062 J1100 J3010 J9060 90378 J3370 J1566 J7192 J9040 J1885 J9206 J1170 J0207

J1040 For more information, call the TMHP Contact Center at 1-800-925-9126 or the TMHPCSHCN Services Program Contact Center at 1-800-568-2413.

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