UB 04 - NDC number

Guidance Regarding NDC’s on the UB-04 Form

Effective August 2008, Alabama Medicaid mandated that the National Drug Code (NDC) number be included on the UB-04 claim form for the Top 20 physician administered drugs as defined by CMS. Alabama Medicaid would like to clarify the required format for the NDC number that is submitted on this claim form. Medicaid requires that each submitted NDC contain 11-digits (no dashes or spaces). The first 5-digits identify the labeler code of the manufacturer of the drug. The next 4-digits
identify the specific strength, dosage form, and formulation of that drug. The last 2- digits identify the package size of the drug.

There may be some instances when an NDC does not contain all eleven digits on the product’s container. In the following instances, the correct format for submission of the NDC in Form Locator 43 (Description) is given:

• xxxx-xxxx-xx; in this case a zero (0) would need to be added in front of the first set of numbers.
Result: 0xxxxxxxxxx.
• xxxxx-xxx-xx: in this case a zero (0) would need to be added in front of the second set of numbers.
Result: xxxxx0xxxxx.
• xxxxx-xxxx-x: in this case a zero (0) would need to be added in front of the third set of numbers.
Result: xxxxxxxxx0x.

Please refer to the Food and Drug Administration (FDA) website below for more
information regarding the National Drug Code, http://www.fda.gov/cder/ndc/index.htm. For additional questions regarding the CMS list of Top 20 physician administered drugs, please contact Pharmacy Services at (334) 242-5050