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Back  RFI # 1948: NDC Units - 2410-CTP04

Formal vs. Informal Help Informal Formal

Submitter

Kim Walker

Description

PA Medicaid pays family planning drug codes based on the way the drug is listed on their Covered Drugs website (http://www.dpw.state.pa.us/provider/doingbusinesswithdpw/pharmacyservices/covereddrugs/index.htm). For example, NDC=00603754017 (EMOQUETTE 28 DAY TABLET ) is paid by the pill. That NDC is listed as "6 BLISTER PACK in 1 CARTON (0603-7540-17) > 1 KIT in 1 BLISTER PACK" on the FDA website. In order to be paid correctly, PA Medicaid requires the quantity reported in 2410-CTP04 to be 168 (28 pills/pack X 6 packs). The White Paper on NDC Reporting issued by WEDI indicates the "NDC quantity in CTP04 is based on the NDC description...". Is PA Medicaid's billing requirement correct?

Submitter Assigned Keywords

Drug Unit CTP04

Response

The 005010X222A1 explicitly states that the National Drug Unit Count is “The dispensing quantity, based upon the unit of measure as defined by the National Drug Code.” However for your specific question, X12 can’t answer if PA Medicaid is correct or not.

Recommendation

The FDA has an eMail address for asking drug related questions, DRUGINFO@FDA.HHS.Gov. Contact the FDA for an interpretation on what is considered a unit in situations such as this.

When an NDC is reported in LIN03, refer to the Billing Unit Standard Fact Sheet in the public section of the NCPDP web site to determine the appropriate code value to use for this data element.
Submission 7/9/2014
Status Date 10/21/2014
Status F - Final
Primary References
Document 005010X222
Section2.4
Page429
Set ID837
Table2
Loop2410
Segment Position4940
Segment IDCTP
Element Position04
Component Position1
Industry NameDrug Identification