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Validating the National Drug Code (NDC) Submitted in Conjunction with Procedure Codes for Physician Administered Medications pdf
Connecticut Medicaid (HUSKY Health)·CT·Pharmacy
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid now validates that the 11-digit National Drug Code (NDC) matches the HCPCS procedure code when billing physician-administered medications. Claims with mismatched NDC and procedure codes will deny with EOB code 839, though the edit is currently in post-and-pay status before future denials begin.
Action Required
Immediately: Billing team must verify all physician-administered drug claims include correct 11-digit NDC codes that match the billed HCPCS codes (J, S, Q series) and CPT codes 90284-90738. Use the Drug Search tool at www.ctdssmap.com to crosswalk NDCs to correct procedure codes. Avoid using unclassified J-codes when specific codes exist. Claims with mismatched NDC/procedure codes will be denied with EOB 839 when the edit moves from post-and-pay to denial status.