Questions Submitted by the Public, by Date Posted to the Website. NDC codes in HCFA 1500


Is the HCFA 1500 going to be revised to hold an 11-digit procedure code for the NDC number? Now it holds a five-digit procedure code and there is space for two modifiers in the next two spaces.


The standards adopted in the Standards for Electronic Transactions Final Rule do not apply to the HCFA-1500 or to other paper forms. The National Uniform Claim Committee (NUCC), which is responsible for the content of the HCFA-1500, has no current plans to revise that form in light of the publication of the Final Rule. However, the NUCC is interested in developing general completion instructions that could be used by many, if not all, health plans. Such instructions would likely address the collection of the National Drug Codes for drugs and biologicals.

Health plans that use the HCFA-1500 may choose to revise their instructions for completing the HCFA-1500 in an effort to collect information that will be the same as or consistent with the standards adopted in the Standards for Electronic Transactions Final Rule. For example, the Health Care Financing Administration (HCFA), which administers the Medicare program, will be making changes to its HCFA-1500 completion instructions in order to collect NDCs. Item 24d of the HCFA-1500 can accommodate up to 12 characters in the combined spaces labeled "CPT/HCPCS" and "Modifier." When reporting an NDC in item 24d, however, another item on the HCFA-1500 would have to be used to capture a modifier or supporting documentation, if that information also needed to be reported.