Trying to determine what pieces of data are required on the 837 that in turn require NDC Loop 2410 information to be conditionally required on the claim.
1) Clarify, if a HCPCS code ALWAYS is required in loop 2400 SV* segment when Loop 2410 NDC is reported? And vice versa?
2) What type of HCPCS code has to be reported in loop 2400 SV* segment in order to report the NDC loop (LIN and CTP)?
3) Are there any revenue code limitations for the 2400 SV* that should or should not require the NDC loop be sent? We have providers state that a revenue code 250 should not have NDC information sent on the claim
4) Can loop 2410 NDC information be sent on 837I or 837P when no HCPCS code is reported in corresponding 2400-SV* segment?
For the 837P, a procedure code is a required data element in the SV1 segment, even if the 2410 loop is not reported. The NDC code cannot be reported without a procedure code in the SV1 segment. See section 1.11 in the 837P for more information regarding using NDC codes and drugs.
ASC X12 has no position on which HCPCS codes or revenue codes are valid to use in combination with a NDC code. Please see the code source as identified in the appendix of the implementation guide for assistance with your request.
For the 837I, please refer to the UB04 manual for when to report an NDC code with specific revenue code values. The manual also provides guidance on when a HCPCS is required with a revenue code or not.
To be compliant with the TR3 the NDC code is required in the 2410 LIN03 when government regulation mandates that prescribed drugs and biologics are reported with NDC numbers or when the provider or submitter chooses to report NDC numbers to enhance the claim reporting or adjudication processes.