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NDC Billing Requirement for Physician Administered Drugs

The Deficit Reduction Act (DRA) of 2005 requires states to collect rebates for covered outpatient drugs administered by "physicians".  In order to comply, states must gather utilization data including the National Drug Code (NDC), quantity and unit of measure from claims submitted for physician administered drugs.

Frequently Asked Questions

Who is included in "physician" administered?

"Physician" also includes APRNs, NPs, PAs, RNs and all other providers identified by Medicare as "non-physician practitioners" whose scope of practice includes the administration of drugs.

Is a hospital outpatient department or emergency room required to report NDCs?

Yes.  CMS published clarification at 42 CFR 447 (Final Rule dated July 17, 2007) in which they clarified conditions relating to physician-administered drugs and based their "interpretation on the statute language that does not differentiate between providers in requiring that States collect information sufficient to bill for rebates for covered outpatient drugs under section 1927(k)(3) of the Act." 

Drugs administered incident to an emergency room service that are billed separately as covered outpatient drugs, as defined by 1927(k)(2) of the Act, are covered under the Medicaid Drug Rebate Program.

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