CMS1500 – BOX 19: RESERVED FOR LOCAL USE

If you are billing a J code in Box 24D, enter the National
Drug Code (NDC) for that drug. Do not enter the description
of the drug, and do not enter NDC before the actual NDC
code. Only one J code may be billed per claim.

NDCs printed on packages often have fewer then 11 digits,
with hyphens (-) separating the number into three segments.
For a complete 11-digit number, the first segment must have 5
digits, the second segment must have 4 digits, and the third
segment must have 2 digits. Leading zeros are added leftjustified,
wherever they are needed to complete a segment with
the correct number of digits.

Package Number                 Zero Fill (5-4-2)                             11-digit NDC
1234-1234-12                     (01234-1234-12)                        01234123412
12345-123-12                      (12345-0123-12)                        12345012312