Do drugs that are billed through a hospital outpatient department require an NDC?
It depends. This requirement does not apply to hospital claims that are paid as part of a bundled rate, such as the claims paid through the bundled hospital Payment Amount Per Episode (PAPE). The requirement applies to professional claims, including Medicare crossover claims. Effective September 15, 2008, MassHealth requires outpatient hospital departments to submit national drug codes with NDC units and appropriate descriptors to accompany claims for those drugs that are billed separately on institutional claim forms that are identified on the claim with a Level II HCPCS code. This requirement includes claims from acute hospitals from other states, chronic disease and rehabilitation hospitals, and some Medicare crossover claims for renal dialysis clinics.
