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NDC Billing Requirement

Documents related to the NDC billing requirements:

Drug-Related Procedure Codes Requiring an NDC

Below are links to a downloadable list of drug-related HCPCS codes requiring an NDC. The list is
provided on both Adobe pdf and Microsoft Excel formats. The list reflects what was in effect at the time of posting and is subject to change.

When a HCPCS code requires an NDC, Wyoming Medicaid will only cover those NDCs that are rebateable per the Omnibus Budget Reconciliation Act of 1990. To simplify the identification of rebateable NDCs, only HCPCS/NDC combinations with rebateable NDCs are shown. Providers are encouraged to use the list to verify an NDC's rebate status prior to billing. NDCs that are not rebateable will cause the respective institutional or professional line item to be denied.

The list of rebateable NDCs also gives providers a way to validate HCPCS/NDC combinations prior to billing. Invalid HCPCS/NDC combinations will also be denied.

**Note: Medicare Crossover Claims**
Because Wyoming Medicaid pays Medicare coinsurance and deductible for dual-eligible clients, NDCs will also be required on Medicare crossover claims for all applicable HCPCS codes on the list. Wyoming Medicaid has verified that NDC information reported on claims submitted to Medicare will be included in the automated crossover claim feed to Wyoming Medicaid.

The requirement will first be implemented for professional crossover claims. Beginning with dates of service on and after March 1, 2008, professional crossover claim lines that are missing a required NDC will be denied. The requirement for outpatient institutional crossover claims will be implemented later in 2008.

As of 12/1/17, Wyoming Medicaid will discontinue posting an NDC/JCode Crosswalk.  Providers must submit their claims with the appropriate NDC and appropriate J-code.  For additional information, please refer to Provider Manual (Chapter 6, National Drug Code (NDC) Billing Requirement).