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Patricia Posted Sun 05th of November, 2017 13:03:56 PM
Hello, I am getting numerous denials on the above CPT codes stating NCD denials? I have verified the NDC on this site. My concern is the NDC on this bottle is not on your NDC list for the CPT codes. Any help would be great. Thanks
SuperCoder Answered Mon 06th of November, 2017 01:59:13 AM

Hi,

Could you please provide the name of the drug administered and the NDC on the bottle(s) for both the CPT codes mentioned above.

 

NOTE:  Billing for medication and vaccines

Following are some general concepts for the use of NDC numbers when submitting claims for medications or vaccines, but refer to your payers for specifics.

In general, the requirements to report a medication or vaccine are:

  • The applicable Healthcare Common Procedure Coding System (HCPCS) code or Current Procedural Terminology (CPT) code

  • Number of HCPCS code or CPT code units

  • 11-digit NDC(s), including the N4 qualifier (which indicate the use of the NDC)

  • Dosage unit of measurement

  • Number of NDC units dispensed (must be greater than 0)

Patricia Posted Mon 06th of November, 2017 10:57:41 AM
CPT 90686 FLUZONE National Drug Code ------> 49281-417-88 NDC Units of Measure ----> ml NDC Quantity ------------> 0.5 Lot Number --------------> UT5936KA Lot Expiration Date -----> 06/30/2018 Manufacturer Code -------> PMC Anatomical Route --------> IM
SuperCoder Answered Tue 07th of November, 2017 01:47:03 AM

Hi,

The possible cause of the denial can be the use of NDC number (49281-417-88) that you are using against FLUZONE in your claim.

FLUZONE is supplied as package of 10 under (NDC 49281-417-50) i.e., NDC package code.

NOTE: If the medication comes in a box with multiple vials, using the NDC on the box (outer packaging) is recommended.

The same NDC (49281-417-50) is available on our site in the available crosswalk against CPT code 90686.

Submit the claim with NDC 49281-417-50 for Fluzone for possible reimbursement.

For more clarity on NDC 49281-417-50 and NDC 49281-417-88, refer the below mentioned links:

https://www.fda.gov/downloads/biologicsbloodvaccines/vaccines/approvedproducts/ucm305089.pdf

https://www.accessdata.fda.gov/scripts/cder/ndc/dsp_searchresult.cfm

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8213c229-a67a-4d3f-bd8f-b8729ae28472

 

Hope it helps!

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