RARC M119: Missing or Invalid NDC Code for Drug Claim
The NDC code for the drug or biological on this claim is missing or invalid — verify the correct National Drug Code and resubmit with the proper NDC, unit, and quantity.
What Does RARC M119 Mean?
M119 flags a problem with the National Drug Code (NDC) on a claim for a drug or biological product. NDC codes are 11-digit identifiers assigned by the FDA that specify the exact manufacturer, product, and package size of a drug. Many payers — particularly Medicaid programs and an increasing number of commercial plans — require NDC codes on claims for drugs administered in a clinical setting, in addition to the HCPCS J-code that describes the drug category.
The NDC requirement exists because a single HCPCS code can cover multiple manufacturers' versions of the same drug, and payers use the NDC to determine the exact product that was administered, calculate accurate reimbursement based on average sales price or wholesale acquisition cost, and track drug utilization. When the NDC is missing, invalid, or does not match the HCPCS code on the same claim line, M119 is triggered.
Common causes include omitting the NDC entirely (some billing systems do not prompt for it by default), entering the NDC from the drug's outer packaging rather than the actual vial or container used, or submitting an NDC that has been discontinued by the manufacturer. The NDC unit of measure and quantity must also be consistent — billing 40 mg of a drug with an NDC that represents a 20 mg vial requires the quantity to reflect two units, not one.
M119 typically accompanies CARC 16 (missing information) or CARC 252 (additional information required).
What to Do
Check the drug label or your pharmacy inventory system to confirm the correct 11-digit NDC for the specific product that was administered. Verify that the NDC corresponds to the exact manufacturer, strength, and package size used. Ensure the unit of measure (such as UN for unit, ML for milliliter, or GR for gram) and quantity match the amount actually administered. Enter the corrected NDC information on the claim and resubmit.
For practices that administer drugs regularly — oncology clinics, infusion centers, rheumatology practices — establishing a process to capture the NDC at the point of administration rather than at billing time can prevent M119 denials. Some EHR systems can scan the drug barcode during administration to auto-populate the NDC. If your practice stocks multiple manufacturers' versions of the same drug, make sure the NDC captured reflects the actual product used for each specific patient encounter, since the NDC may change when you switch suppliers.
Common Scenarios
- An oncology practice bills for a chemotherapy drug with the HCPCS J-code but omits the NDC because the billing system does not require it by default, and the Medicaid plan denies the claim with M119.
- A clinic administers a biosimilar product but enters the NDC for the reference biologic because the charge was built before the biosimilar was stocked, creating a mismatch between the NDC and the actual product given.
- A physician's office bills for an injectable drug using an NDC from a discontinued package size that is no longer recognized by the payer's drug database.
Commonly Paired With
No common pairings documented yet.