Unclassified or Not Otherwise Classified (NOC) Drug Codes: Rejected if Not Submitted Correctly
When billing for services using the unclassified drug codes or not otherwise classified (NOC) drug codes, it is important to submit only the required documentation. Submitting additional information beyond what is required, or submitting conflicting information, could cause the service to be rejected.
Required Documentation
- The drug name
- The total dosage (this is amount actually administered)
- The National Drug Code (NDC) number
As a reminder, please do not file unlisted codes for procedures (e.g., surgical) without indicating a description of the service being provided for payment.
The documentation is to be entered in the appropriate comment/narrative field.
Correctly Reporting the Amount of a Drug Being Billed
When providers report the quantity of a drug that was administered, it should be expressed in the unit of measure that is appropriate for that drug or biological. NOC drugs should be reported in total strength. Drugs amounts expressed in "mg/mL" or "mg mL" will be rejected for insufficient information. The only exception to this will be compounded drugs which can be reported as "mg/mL."
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Electronic Claims
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Loop 2300, NTE, 02
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Claim Level Comment (Claim Notes):
Used when the documentation does not apply to a specific service line; documentation is applied to entire claim.
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Loop 2400, NTE, 02
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Line Level Comment (Line Notes):
Used when the documentation applies to a specific service line; documentation is applied to that service line only.
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Loop SV101-7
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Required description loop for NOC/unclassified drug codes for the specific service line.
Note: This is a CMS-mandated field and will reject if not completed.
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Paper Claims
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Box 19
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Enter claim information in this item; if submitting on an attachment, there must be an indication in box “Box 19” to refer to the attached documentation.
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Attachment
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Attach documentation pertaining to services billed on 1500 claim form.
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In order to avoid rejections, resubmissions, etc., please ensure when submitting the required documentation to only submit what is required and be sure the information is not conflicting. This is especially important when it comes to the dosage being submitted.
Examples of Incorrect and Correct Submissions
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(Recommended Submission) Correctly Submitted Documentation
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Loop 2300 Comment (Claim Note):
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Blank, nothing submitted in header comment
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Loop 2400 Comment (Line Note):
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Blank, nothing submitted in Line Note
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SV101-7 Comment (Line comment):
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Famotidine 20 mg 63323073912
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Outcome: Processed per the 20 mgs as indicated.
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Note: Drug name, total dosage and NDC have all been submitted in SV101-7 line comment only. This is how we recommend the information to be submitted.
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Conflicting Information
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Loop 2300 Comment (Claim Note):
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Blank, nothing submitted
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Loop 2400 Comment (Line Note):
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Testopel 75mg 43773100103
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SV101-7 Comment (Line):
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Testopel 600 mgs
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Outcome: Rejected; were 75 mgs or 600 mgs actually administered?
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Note: If 600 mgs was administered, only indicate 600 mgs and not the 75 mgs. If 75 mgs was administered, only indicate 75 mgs and not the 600 mgs.
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Conflicting Information
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Loop 2300 Comment (Claim Note):
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Valproate Sodium
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Loop 2400 Comment (Line Note):
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Valproate Sodium 1000 mg 00074156410, 500 mg vials
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SV101-7 Comment (Line comment):
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Valproate Sodium 500 mg vials
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Outcome: Rejected; were 1,000 mgs or 500 mgs actually administered?
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Note: If 1,000 mgs was administered, only indicate 1,000 mgs and not the 500 mgs. If 500 mgs was administered, only indicate 500 mgs and not the 1,000 mgs.
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Correctly Submitted Documentation
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Loop 2300 Comment (Claim Note):
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Blank, nothing submitted in header comment
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Loop 2400 Comment (Line Note):
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Valproate Sodium 500 mg 00074156410
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SV101-7 Comment (Line comment):
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Valproate Sodium 500 mg 00074156410
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Outcome: Processed per the 500 mgs as indicated.
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Note: Both the Line Note comment and SV101-7 comment indicate the same dosage.
Quantity Billed/Number of Services
Providers should enter “1” in the quantity billed/number of services field and enter the total amount of the drug or biological actually administered (in mg or mcg) in block 19 or the electronic equivalent field.
If any of the required documentation is missing, incomplete or invalid, the service(s) will be rejected.
Drugs Requiring Invoices/Supporting Documentation
Please refer to the “Services and Circumstances that Require Additional Documentation” article found on Palmetto GBA’s website.
Drugs Requiring Only Comment in Narrative/Block 19
Besides the required documentation (name, dosage and NDC), some drugs may require additional comments in the narrative. These situations would be addressed in an article for the specific drug on CMS Medicare Coverage Database (MCD). For other references of required information, refer the FDA Website.