NCPDP Field Required on CII prescriptions, effective September 21, 2020.
On January 24, 2020, the CMS-0055-F final rule regarding a modification to the use of the Telecommunication D.0 Standard was published in the Federal Register. This final rule is not a modification of the standard itself. The modification to the NCPDP D.0 Standard involves treating Quantity Prescribed (460-ET) as required when the transmission is for a Schedule II controlled substance as defined in 21 CFR 1308.12. This modification enables covered entities to clearly distinguish in a HIPAA retail pharmacy transaction if a prescription is a “partial fill” where less than the full amount prescribed is dispensed under the CARA provision. This is a modification to ensure information is available to help prevent impermissible refills of Schedule II drugs and to yield better data for researchers to enhance understanding of prescribing trends. CMS believes this modification will assist with addressing the public health concerns associated with prescription drug abuse in the United States.
CMS-0055-F, EFFECTIVE DATE: March 24, 2020
This is the date covered entities can begin using the Quantity Prescribed field for Schedule II prescriptions.
CMS-0055-F, COMPLIANCE DATE: September 21, 2020
This is the date that all covered entities must require this field for all Schedule II prescriptions.
On September 21, 2020, pharmacy providers must enter a value in the ‘Quantity Prescribed’ field (460-ET) on all Schedule II prescription claims. Requiring the Quantity Prescribed field will allow for calculations in pharmacy systems so that the total quantity dispensed of a Schedule II controlled substance does not exceed the quantity prescribed.
The Quantity Prescribed field (460-ET) is different than the Quantity Dispensed Field(442-E7).
If a value is not submitted in the Quantity Prescribed field, NCPDP Edit ‘ET-INV QUANTITY PRESCRIBED’ will post and return the NCPDP 526 message “QUANTITY PRESCRIBED REQUIRED WHEN BILLING DEA SCHEDULE II DRUGS”.
The current Mississippi Medicaid Fee For Service NCPDP Payer Sheet can be found at this link https://medicaid.ms.gov/wp-content/uploads/2019/10/MS-NCPDP-1.pdf