NDC & product identity

NDC exclusion list

Definition

A payer-maintained list of drug codes that will not be reimbursed under a given benefit, regardless of medical necessity.

Exclusions usually target self-administered drugs on a medical benefit, compounded preparations, or products with no established pricing. A denial that cites an exclusion list is not appealable on clinical grounds — the drug has to be billed under a different benefit.

Self-administered drugA drug that a patient can reasonably administer themselves, which therefore falls outside the medical benefit.Definition Denial codeA code on a remittance advice explaining why a claim or line was not paid as billed.Definition

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10-digit NDC 11-digit NDC 4-4-2 format 5-3-2 format 5-4-1 format 5-4-2 format Kit (NDC)Labeler code

All 153 terms Coding guide J-code directory

NDC exclusion list

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