UHC Reimbursement

Change to NDC Reimbursement Policy for UHC Outpatient Facilities

For dates of service on or after Nov. 1, 2019, the National Drug Code (NDC) policy for UnitedHealthcare Medicare Advantage plans, including all UnitedHealthcare Dual Complete plans, will be revised for drug-related codes in outpatient facilities.

With this policy change, care providers who are contracted with us who submit claims for drug-related Healthcare Common Procedure Coding System (HCPCS) and CPT codes in an outpatient facility will be required to include the following information on the claim,

• A valid NDC number
• Quantity
• A unit of measure

If the required information isn’t included, the claim may be denied. The NDC requirement will apply to all claims submitted on the CMS-1500, Electronic Data Interface (EDI) 837p, CMS UB-04 and EDI 837i claim forms. 

Reason for Changes:

As the industry standard identifier for drugs, NDCs provide full transparency to the medication administered. They accurately identify the manufacturer, drug name, dosage, strength, package size and quantity.

Will keep you posted list of CPT codes at the earliest

Reference: https://www.uhcprovider.com/content/dam/provider/docs/public/resources/news/2019/network-bulletin/August-Network-Bulletin-2019.pdf#page=27

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