Encounters with Revenue Code 25x or 63x with NDC and a DOS prior to 5/1/2022

To adhere to federally required rebate guidelines, North Carolina Medicaid requires the submission of a HCPCS code with an NDC on all drug claim lines with Revenue codes 0250-0259 and 0631-0637 submitted on outpatient hospital institutional claims (which are billed on a UB-04 / 837-I). 

The Department has received requests from Standard Plans to accept paid encounters for dates of service prior to 5/1/2022 for revenue codes 025x and 063x, which do not include an NDC and/or HCPCS code. Providers must use Centers for Medicare and Medicaid (CMS) guidance and industry standards to associate the correct NDC to its correct HCPCS code.

As stated in the Managed Care Billing Guide section 3.19.1 Revenue Codes and NDC Codes, all institutional and professional claims must include a valid 11-digit NDC code for each claim detail line that includes a drug procedure code. All pharmacy related revenue codes (including 025x and 063x) are required to also have a MCPC’S code reported.