Requirements for National Drug Codes Submission for Physician Administered Drugs
Blue Shield of California Promise Health Plan requires claims and encounters reporting Physician Administered Drugs (PADs) to include both the Healthcare Common Procedure Coding System (HCPCS) code and a valid National Drug Code (NDC) for Medi-Cal members.
The Department of Health Care Services (DHCS) began enforcing this requirement effective July 1, 2019.
The requirements for 837P and 837I submissions are as follows:
If the procedure code reported in 837P 2400/101-02 or 837I 2400/202-01 is provided in the monthly list sent by the Encounter Data Quality Unit from DHCS, then the following drug information must be populated:
| 837 Loop/Segment | Expected value |
|---|---|
| 2410/LIN02 | N4 |
| 2410/LIN03 | NDC |
| 2410/CTP04 | Drug quantity |
| 2410/CTP05-1 | Drug measurement code |
| 2410/REF | Required, if involved the compounding of two or more drugs |
- NDC must be a valid code
- NDC must be 11 numeric digits, all zeroes will not be accepted
The current HCPCS code list is distributed by DHCS. Each HCPCS code in the list must be accompanied by a valid NDC.
Blue Shield Promise Health Plan will deny claims that do not meet these requirements. All claims denied by Blue Shield Promise must be corrected and resubmitted.
If you have any questions on how to submit this information electronically, please contact the EDI Help Desk at:
Phone: (800) 480-1221
DHCS HCPS code list
Review the list of procedures requiring additional drug information.
EDI companion guides
Access our companion guides for trading partners who exchange electronic transactions directly with us.
Local code encounter crosswalk
Find the national codes that must replace local billing codes. For billing claims, Blue Shield Promise continues to utilize Medi-Cal local codes following the Medi-Cal Fee-for-Service Program's phased approach to convert the interim (local) codes to national values.