Anthem to require NDC on claims for certain physician-administered drugs

November 12, 2014
Area(s) of Interest: Drug Prescribing/Dispensing Patient Care Practice Management 

On September 30, Anthem Blue Cross notified physicians that effective January 1, 2015, it will require all professional providers to bill using the 11-digit National Drug Code (NDC) for drugs administered in a physician’s office. 

In the notice, Anthem says that currently, the lack of uniform coding system for drugs can result in inaccurate payments. The payor also states the change will allow it to be more consistent with Medicaid requirements and maintain consistent claims billing guidelines across all Anthem products.

While the notice said the NDC would be required for all professional providers submitting claims “for drugs administered in a physician’s office,” it also indicated that the payor would only deny claims for “Not Otherwise Classified [NOC] or Miscellaneous drug HCPCS” that did not include the NDC. The California Medical Association discussed this apparent contradiction with Anthem, and the payor confirmed that the change only applies to physician-administered drugs in a physician’s office for NOC or miscellaneous HCPCS codes.

Anthem also said that the policy change does not affect vaccine CPT codes.

Practices with questions about the policy change can contact Anthem Network Relations at networkrelations@wellpoint.com.


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