2025 Prescription Drug Event (PDE) File Layouts: Update to Field 19, QUANTITY PRESCRIBED, Field Name, NCPDP Field and Definition/Values
Effective January 1st, 2025, CMS changed the field identifiers for Field 19. This change impacted the FIELD NAME, NCPDP FIELD and DEFINITION/VALUES columns for Field 19 on the PDE-Inbound-File-Layout-Final-20250101_Q1-2024 file. This change also impacted the FIELD NAME and DEFINITION/VALUES columns for Field 19 on the PDE-Outbound-File-Layout-Final-20250101_Q1-2024 file. This change had no impact on the format a plan should use for POSITION, PICTURE or LENGTH for the PDE-Inbound-File-Layout-Final-20250101_Q1-2024 file or the PDE-Outbound-File-Layout-Final-20250101_Q1-2024 file.
Previous PDE-Inbound-File-Layout-Final-20250101_Q1-2024:
DET
FIELD NAME: ORIGINALLY PRESCRIBED QUANTITY
NCPDP FIELD: 446-EB
DEFINITION/VALUES: Required for Schedule II drugs that are reported as standard, electronically-submitted PDEs with a DOS >= 01/01/2025. This field must contain the originally prescribed quantity. Must be zero for DOS < 01/01/2025, or for non-Schedule II PDEs.
Previous PDE-Outbound-File-Layout-Final-20250101_Q1-2024:
DET
FIELD NAME: ORIGINALLY PRESCRIBED QUANTITY
DEFINITION/VALUES: Required for Schedule II drugs that are reported as standard, electronically-submitted PDEs with a DOS >= 01/01/2025. This field must contain the originally prescribed quantity. Must be zero for DOS < 01/01/2025, or for non-Schedule II PDEs.
Revised PDE-Inbound-File-Layout-Final-20250101_Q1-2024:
DET
FIELD NAME: QUANTITY PRESCRIBED
NCPDP FIELD: 460-ET
DEFINITION/VALUES: Required for Schedule II drugs that are reported as standard, electronically-submitted PDEs with a DOS >= 01/01/2025. This field must contain the quantity prescribed. Must be zero for DOS < 01/01/2025, or for non-Schedule II PDEs.
Revised PDE-Outbound-File-Layout-Final-20250101_Q1-2024:
DET
FIELD NAME: QUANTITY PRESCRIBED
DEFINITION/VALUES: Required for Schedule II drugs that are reported as standard, electronically-submitted PDEs with a DOS >= 01/01/2025. This field must contain the quantity prescribed. Must be zero for DOS < 01/01/2025, or for non-Schedule II PDEs.
CMS recommends making the change from ORIGINALLY PRESCRIBED QUANTITY (446-EB) to the use of the QUANTITY PRESCRIBED (460-ET). Quantity Prescribed is a necessary data element to support point of service adjudication rules to determine whether the Schedule II controlled substance claim is an incremental fill to the prescribed quantity.
The updated 2025 PDE Inbound and Outbound File Layouts are published for your reference on the File and Report Layouts page of the CSSC Operations website, with the updated text reflected in red font.
In the event you have questions, please contact CSSC Operations at 1-877-534-2772 (option 2) or by email at https://www.csscoperations.com.