DEPARTMENT OF SOCIAL SERVICES
DEPARTMENT OF SOCIAL SERVICES
DIVISION OF MEDICAL SERVICES
700 GOVERNORS DRIVE
PIERRE, SD 57501-2291
PHONE: 605-773-3495
FAX: 605-773-5246
WEB: dss.sd.gov
December 10, 2007
Re:
National Drug Code (NDC) Billing Requirement for Drug-Related HCPCS
J-Codes
Dear South Dakota Medicaid Prescribing Provider:
To comply with Centers for Medicare and Medicaid Services (CMS) requirements related to
the Deficit Reduction Act (DRA) of 2005, a change involving drugs administered in an office or
other outpatient setting are due to become effective January 1, 2008.
The rules mandate all state Medicaid agencies require providers who use a drug-related
Healthcare Common Procedure Coding System (HCPCS) J-code when billing prescription
drug products to include the relevant National Drug Code (NDC) of the drug dispensed. This
requirement will apply to electronic and paper claims submissions. The quantity of each NDC
submitted and the unit of measurement qualifier will also be required.
Realizing our providers need as much time as possible to make programming changes to
comply with these requirements, the South Dakota Department of Social Services, Division of
Medical Services, is requesting a one year extension from CMS. This extension will also allow
greater time for provider input and education. At least 13 other state Medicaid programs have
or are in the process of also requesting extensions. Approval of the extension is anticipated. If
South Dakota is granted the request, these requirements will become effective January 1,
2009.
For additional information and updates please refer to the Medical Services Provider
Information website at the following web address:
http://dss.sd.gov/medicalservices/providerinfo
Sincerely,
Larry Iversen
Medicaid Director
Division of Medical Services
