Examples of NDC Qualifiers

Example #1 Pegfilgrastim

  • J2505 = 6mg.
  • Each syringe administered equals 1 J-code unit.
  • Available as a 6mg/0.6mL syringe.
  • The conversion factor is 1.66 so the NDC quantity is 1/1.66 = 0.6.
  • The unit qualifier is "mL."

Example #1 Pegfilgrastim

Example #2 Trastuzumab

  • J9355 = 10mg.
  • Each vial contains 440mg or 44 J-code units.
  • The conversion factor is 44 so the NDC quantity is 44/44 = 1.
  • Even though it is an MDV, it is listed as "Each" which is reported with the unit qualifier "UN" for unit.

Example #2 Trastuzumab

Example #3 IVIG

  • J1459 = 500mg.
  • 100 gram dose = 200 J-code units.
  • Available as 10% solution (10g/100ml).
  • The conversion factor is 0.2 so the NDC quantity is 200/0.2 = 1000.
  • The unit qualifier is "mL."

Example #3 IVIG

Example of 5-4-2 Format

 Package NDC

 NDC to submit (Missing zero)

 xxxx-xxxx-xx (4-4-2)

 0xxxx-xxxx-xx (5-4-2)

 xxxxx-xxx-xx (5-3-2)

 xxxxx-0xxx-xx (5-4-2)

 xxxxx-xxxx-x (5-4-1)

  xxxxx-xxxx-0x (5-4-2)

Another example:

  • Bottle/invoice says 1234-5678-90. This is a 4-4-2.
  • The section that doesn't fit the 5-4-2 submitting format is the first number section because it only contains four numbers.
  • A zero is placed at the beginning of that section, creating the correct 01234-5678-90.
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