HCPCS Drug code submission in CMS 1500

To submit a claim for a HCPCS Drug Code, complete field 24 as follows:

• Field 24D – Enter the HCPCS Drug Code in the primary field (bottom),

• In the supplemental field (top shaded area) enter the appropriate NDC code(s) as follows:

o Maximum of three NDCs per drug code

o Qualifier N4 must precede each NDC

o Enter NDC information in field 24D through field 24H

o No space, hyphen or other separator should be entered between the qualifier and the NDC number. Example: N422222222222

o Each qualifier + NDC code must be separated by a space or comma

Example: N422222222222 N466666666666 N488888888888 or
N422222222222,N466666666666,N488888888888