J3490 drug description. Jan 1, 1997 · J3490 - Drugs unclassified injection.

J3490 drug description Medicare data supports that these drugs are self-administered by more than 50 percent of Medicare beneficiaries; therefore, the following drugs have been added to the Self-Administered Drug (SAD) Exclusion List: Xembify® (Injection, immune globulin) (J1558), Avonex® (interferon beta-1a) (J1826), Besremi® (ropeginterferon alfa-2b) (J3490 administration of the drug is payable if the drug would have been covered if the physician purchased it. When billing Medicare, report one unit of service in the 2400/SV1-04 data element or in Effective with date of service Jan. 50% 1ml 10. This includes: 1. Request a Demo 14 Day Free Trial Buy Now Jan 17, 2024 · The J3490 code is a Healthcare Common Procedure Coding System ‌(HCPCS) Level II code‌ used ⁣to bill‌ for⁤ drugs that do not have a specific HCPCS code. 14. This article contains billing and coding guidelines that complement the Local Coverage Determination (LCD) Drugs and Biologicals, Coverage of, for Label and Off-Label Uses. The Health and Human Services Commission (HHSC) completed a review of drugs and products associated with procedure code J3490. List all NDCs for each drug administered in item 24 of the CMS-1500. SV101-7 in theANSI 837 claim file). 1 Major depressive disorder, recurrent, moderate F33. Unlisted codes are not interchangeable, so please be sure you are using the most appropriate code to avoid claim rejections. ‹‹Table of Drugs and Supplies Dispensed Onsite›› HCPCS Code Description A4261 Cervical cap for contraceptive use Ferumoxytol Feraheme Iron therapy X X X X X Closed 12/31/09(not billable with J3490). Bevacizumab is billed using J9035, while its recently approved biosimilars have been assigned specific Q-codes (Table 1). Use the appropriate J code to report the drug being used. 20. Specifically, J3490 is categorized as an “unclassified drug” code, serving as a catch-all designation for injectable medications that lack a defined or specific HCPCS code. Q5146 replaces C9399, J3490, J3590, J9999 when billing for Hercessi ® (trastuzumab-strf) Effective Jan. C9399 HOPD, ASC c Unclassified drugs and biologicals J3490 Physician Office Unclassified drugs Product Code (NDC) d Bupivacaine/Meloxicam Billable Unitse 47426-0301-02 400 mg/12 mg 1 47426-0303-01 200 mg/6 mg 1 Modifier Description JW Drug amount discarded/not administered to any patient (indicate quantity discarded) CODING REFERENCE GUIDE Drug Policy Replaced HCPCS codes J3490 and J3590 with J1414 Genetic Testing for Hereditary Cancer; Medical Policy Removed CPT codes 81433, 81436, and 81438: Revised description for CPT codes 81432 ,81435, and 81437 Immune Globulin (IVIG and SCIG) • Medical Benefit Drug Policy Added HCPCS code J1552 Antilirium – 1 mg/ml: Ascorbic Acid – 500 mg/ml: Ascorbic Acid – 250 mg/ml: Bacitracin, Intramuscular – 50,000 unit vials: Bacitracin, Intramuscular – 10,000 unit vials drug list may contain different drugs after changes to the initial drug list are approved. J2506 replaces J3490 and J3590 when billing for Neulasta . 31, 2024. 3. Durable Medical Equipment, Prosthetics / Orthotics, and Supplies & Parenteral and Enteral Nutrition Items and Services. Claim Billing instructions: For services billed using J3490, all claims are billed as paper claims and must include the NDC, the drug name and strength, and cost invoice where applicable. May 9, 2016 · Unclassified HCPCS codes can only be used when there is not a specific HCPCS code available for the drug being billed. J3490 belongs to Medical Care Type of Service and has been in effect since Jan 01, 1997. " A drug is defined as a chemical (or synthetically made) given to diagnose, treat or prevent illness. Aug 24, 2021 · Effective with date of service July 8, 2021, the Medicaid and NC Health Choice programs cover oritavancin for injection, for intravenous use (Kimyrsa™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs. Revenue Code Guidance for Unlisted Drug on HOPD claim (J9999,J3490,J3590,C9399) Could someone clarify if the rev code for the unlisted drug code would remain 0636 or if it would shift to 0250? With the admin codes at 0260, this puts the drug at the top of the claim and not at the 2025 DME Fee Schedule for J3490. Oct 1, 2015 · Under Excluded CPT/HCPCS Codes – Table Format deleted C9399, J3490 and J3590 for the drugs Omvoh™ (mirikizumab-mrkz) and Wezlana™ (ustekinumab-auub). 1, 2020, the Medicaid and NC Health Choice programs cover famotidine injection (Pepcid®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs. 27, 2023, the Medicaid and NC Health Choice programs cover lenacapavir injection, for subcutaneous use (Sunlenca) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs. True codes reflect the dosage of the drug; the number of units should indicate the total number of • Below are examples of covered Medicare Part B drugs and biologicals, not be inclusive, along with a resource for coverage information • Antigens • Blood clotting factors • Drugs used with DME • Erythropoiesis Stimulating Agent • Injectable and infused drugs • Injectable osteoporosis drugs • Oral antinausea drugs Dec 1, 2019 · The medication used with the injection is reported with a HCPCS Drug code “J-code” or a revenue code. Short description for J3490 HCPCS code: Drugs unclassified injection Short Description: Drugs unclassified injection: HCPCS Coverage Code : D - Special coverage instructions apply: HCPCS Action Code : N - No maintenance for this code: HCPCS Action Effective Date : January 01, 1997: HCPCS Code Added Date : January 01, 1986: HCPCS Pricing Indicator Code : 51 - Drugs: HCPCS Multiple Pricing Indicator Code Feb 17, 2025 · However, this compound drug formulation is required to be billed under one procedure code, J3490 (Unclassified drugs), and the same procedure code must be reported on three separate details on the claim and paired with different NDCs. Four claims were found for nelarabine substitute fludarabine phosphate (J8562) as it is an oral drug and is less likely to be administered in the medical facility. To report new drugs and biologicals, approved by the Food and Drug Administration, for which there are no specific HCPCS codes assigned, use HCPCS code C9399, "unclassified drugs or biologicals". When billing a compounded drug, use HCPCS code J3490 or J7999 and list each drug and its dosage in the descriptor field. Jul 16, 2013 · National Drug Codes (NDC) associated with procedure code J3490 (Unclassified drugs) will change for Texas Medicaid beginning with date of service on or after February 15, 2016. May 9, 2016 · The following are tips to help you when billing NOC drugs and biologicals, such as J3490, J3590, and J9999. 0 Major depressive disorder, recurrent, mild F33. For example: Drug C9399 (unclassified drugs or biologicals) Administration 96413 (chemo infusion for 1st hour, single or initial drug) The units of drug or biologic administered must be reported in multiples of the dosage specified in the procedure code description. National Drug Code (NDC) number (if available) 4. Excerpted From ASP File for April 1, 2018-June 30, 2018 Family PACT – Drugs: Onsite Dispensing Billing Instructions Page updated: October 2021 HCPCS Codes for Drugs and Supplies Dispensed Onsite The HCPCS codes for drugs and supplies dispensed in clinics are as follows. Sep 26, 2023 · What is CPT code J3490 used for? Meloxicam Injection, for Intravenous Use (Anjeso™) HCPCS Code J3490: Billing Guidelines. Healthcare Common Procedure Coding System Code: J3490. All unlisted drugs must be submitted with a narrative and dosage or NDC and are manually priced. Abstract: Ranibizumab, a recombinant humanized immunoglobin G, kappa monoclonal antibody fragment, is a vascular endothelial growth factor A (VEGF-A) antagonist used as an Each drug/biological defines dosage amount in its description For Medicare Part B billing purposes, the units of service on the claim for a drug/biological are entered in multiples of the units shown in the HCPCS narrative description Billing examples CMS IOM, Publication 100- 04, Medicare Claims Processing Manual, Chapter 17, Section 70 Feb 15, 2021 · Unlisted codes are used when a drug or biological does not have a specific HCPCS code assigned to it. It serves as a placeholder code in situations where there is no appropriate code available for a specific drug or product being billed. Dec 14, 2023 · Effective with date of service July 31, 2023, NC Medicaid Direct and NC Medicaid Managed Care cover rezafungin for injection, for intravenous use (Rezzayo) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs. All services will continue to be reported with code C9399, J3490, J3590 and J9999 through Dec. Jul 19, 2024 · J3490 is a miscellaneous code used for drugs that do not have a specific Healthcare Common Procedure Coding System (HCPCS) code assigned to them. BCBSTX checks the NDC numbers and the NDC units submitted with an unlisted drug code to ensure these codes are being billed correctly. Fees shown below are effective July 1, 2025. Jan 1, 1997 · J3490 - Drugs unclassified injection. Lexi-Drugs compendium has been added to the “Abstract” section of the article and Lexi-Drugs Web site has been added to the “Sources of Information” section. J9999: This code signifies a not otherwise classified, anti-neoplastic drug (medication used to treat cancer).   Each NDC associated with an unclassified drug code should be submitted on a separate claim line following the instructions specified in the Manual for Physicians and Providers- Coding and Filing When billing a compounded drug, use HCPCS code J3490 or J7999 and list each drug and its dosage in the descriptor field. 2 Major depressive disorder, recurrent severe without psychotic features Jun 1, 2024 · Most compounded drugs are billed under the Healthcare Common Procedure Coding System (HCPCS) using “not otherwise classified” J-codes, J3490 or J3590. 2. Compounded drugs typically come in the appropriate dosage, so there would be no wastage and no need to use modifier –JW. Effective 6/30/09. 100-04 Medicare Claims Processing Manual, Chapter 17, section 40. u. Criteria for approval of Prior Authorization Drug: 1. Mar 9, 2025 · However, this compound drug formulation is required to be billed under one procedure code, J3490 (Unclassified drugs), and the same procedure code must be reported on three separate details on the claim and paired with different NDCs. Drug doses used in narrative description must be in mgs or mcgs only. Justification A description of the drug and/or biological and dosage must be entered in the narrative field of the claim. Medically reviewed by Leigh Ann Anderson, PharmD. gov/Medicare/ Medicare-Fee-for-Service-Part-B Drugs/ McrPartBDrugAvgSalesPrice/2019ASPF Apr 15, 2014 · April 15, 2014 – Updated 08. The ICD-10-CM code used on each detailed line must represent the condition treated by the drug(s) billed on that detail line. Diagnosis Code Description F33. Providers submit NOC codes in the 2400/SV101-2 data element in the 5010 professional claim transaction (837P). Oct 1, 2015 · List each drug with the applicable dosing amount, for example morphine 20mg, bupivacaine 6 mg, baclofen 4 mcg, sufentanil 5 mcg. Dec 15, 2020 · Effective with date of service Jan. For dates of service prior to 04/01/2016, HCPCS code J3490 should be used. ⁢ This code is used for billing purposes ⁣when a⁤ drug cannot be identified by a specific National Drug Code (NDC) or when a specific‌ NDC is ⁢unavailable. *C3999 should only be used for ASC outpatient facility claims. Appealing Unlisted Drug Allowances Unlisted drug codes, such as J3490, should only be submitted if there is no other code that describes the drug given. There may be times when the invoice cost of the drug may be significantly higher than our allowance. After the first year, the code will typically be replaced by a specific code. Description This policy addresses coverage and reimbursement for Cellular and Gene Therapy Products. 00 J3490 Unclassified drugs J3590 HCPCS Code Description J3490 Unclassified drugs S0013 Esketamine, nasal spray, 1 mg . revenue code 0636 (drugs requiring detailed coding) Revenue Code Description For each item, enter the description of the revenue code used Drug Code Enter the appropriate HCPCS codes. Prior Authorization Group – Drugs / Biologics Not Otherwise Classified PA . HCPCS code J3490 - Unclassified drugs Nov 14, 2024 · Directorio de Códigos Nacionales de Medicamentos (Spanish Version) . For groups that have opted out of the Medical Benefit Drug Prior Authorization program, this service isn’t a covered benefit. If the description for the drug code is 50 mg, and 200 mg of the drug was administered to the patient, the units billed should be a total of 4. J3490 is a valid 2023 HCPCS Code that could be used to indicate Unclassified drugs for reimbursement purposes. Claims for HCPCS codes J9999 (not otherwise classified anti-neoplastic drugs), J3490 (unclassified drugs) and/or J3590 (unclassified biological drugs) must be submitted with additional qualifying information. The following unclassified drug codes should be used only when a more specific code is unavailable: J3490 - Unclassified drugs; J3590 - Unclassified biologics; J9999 - Not otherwise classified, anti-neoplastic drug Mar 15, 2017 · If the drug is compounded, the invoice/acquisition cost must be included with the description. Coding Guidelines 1. HCPCS Code: J3490. For Medicare, bill HCPCS code J3490 (Unclassified drug) for testosterone pellets. Xgeva & Prolia Injection (CPT Code J0897) Description of J0897: Injection, denosumab, 1 mg As described in the CMS IOM Pub. Use HCPCS code J3590 for unclassified or NOC biologics. NOC Code Description PHC NOC Code Alternatives: C9399 Unclassified drugs or biologicals ¾ J3490: drugs, any type; J3490 is interchangeable with Z7610. Drug name 2. Apr 18, 2022 · Effective with date of service April 18, 2022, the Medicaid and NC Health Choice programs cover lanreotide injection, for subcutaneous use for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs. Feb 17, 2025 · J3490: This code represents unclassified drugs administered via injection. Medicare provides only limited benefits for outpatient prescription drugs. Reference: OIG report April 2014. What is a National Drug Code (NDC)? The NDC, or National Drug Code, is a unique 10-digit or 11-digit, 3-segment number, and a universal product identifier for human drugs in the United States. Toggle navigation. Unclassified drugs Code effective 01/01/1997 - present Prescription drug, oral, non chemotherapeutic, nos Code effective 01 J0589 replaces C9399, J3490, J3590 and J9999 when billing for Daxxify ® (daxibotulinumtoxinA-lanm) Effective April 1, 2024, CMS has established a permanent procedure code for the specialty pharmacy drug Daxxify (daxibotulinumtoxinA-lanm). The Healthcare Common Prodecure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs. Do not report µgs. J3490 - Drugs unclassified injection. If no specific code has been established after the first year, you should bill with one of these codes: Use HCPCS code J3490 for unclassified or NOC drugs. List the units of service as one in 2400/SV1-04 data element of the ANSI X12 J3490 Unclassified drugs HCPCS Procedure & Supply Codes. Definitions HCPCS codes include medical therapies and drugs that ordinarily cannot be self-administered, such as chemotherapy drugs, immunosuppressive drugs, inhalation solutions, and other miscellaneous drugs, solutions, and implants. HCPCS J3490 (unclassified drug) and J3590 (unclassified biologic) are the HCPCS codes that are reported for medications that are biological but have not yet been established, to which the HCPCs code has been assigned. When billing an NOC code, providers are required to provide a description in the 2400/SV101-7 data element. Provider Purchases SPRAVATO® From an Authorized Distributor and Bills for Drug and Services Physician Office Treatment visit and drug Medicare G2082 or G2083* N/A Non-Medicare G2082 or G2083* Payer discretion 99202-99205; 99212-99215 Drug: S0013 or J3490 Prolonged Clinical Staff Services: 99415; 99416 Prolonged Service: 99417 Hospital Oct 1, 2015 · The following new drugs have been added: Vedolizumab (Entyvio®) subcutaneous use* (C9399, J3490, J3590), Adalimumab-aaty (Yuflyma) (C9399, J3490, J3590) and Mirikizumab-mrkz (Omvoh™) subcutaneous use* (C9399, J3490, J3590) effective for dates of service on or after 1/14/2024. Search. HCPCS Code NDC NDC Description NDC Quantity* J3490 00409156029 Bupivacaine, 0. Short Description Drugs unclassified injection Drugs administered other than oral method, chemotherapy drugs J3490 is a valid 2025 HCPCS code for Unclassified drugs or just “Drugs unclassified injection” for short, used in Medical care. ¾ J3590: biologics only ¾ S5000/S5001: drugs available through the Family Planning and Wellness & Recovery Benefits ¾ Z7610: drugs, any type. Home claim submission guidelines Billing unlisted drug procedure codes Nov 22, 2024 · Instead, providers should bill J3490 (unclassified drugs); J3590 (unclassified biologics); J7999 (compounded drug, not Oral) or J9999 (Not Otherwise Classified (NOC), antineoplastic drug). See Q0138 & Q0139 afer this date. HCPCS Code J3490 is used for non-coded drugs unlisted NDC number. HCPCS Code2 Description Site of Service J3490 Unclassified drugs Physician Office and Hospital Outpatient J3590 Unclassified biologics Physician Office and Hospital Outpatient J9999 Not otherwise classified, antineoplastic drugs Physician Office and Hospital Outpatient *For site of service hospital outpatient department – Medicare claims. Oct 23, 2024 · If the description for the drug code is 8 milligrams (mg), and 8 mg of the drug was administered to the patient, the units billed should be 1. Need more information about J3490? Get access to fees, crosswalks Free, official coding info for 2025 HCPCS J3490 - includes code properties, rules & notes nd more. It is essential to follow specific guidelines to ensure proper reimbursement and avoid potential billing errors or denials. HCPCS Code Short Name: Drugs unclassified injection. Search results for “J3490” 3 days ago · ForwardHealth will cover the following additional HCPCS procedure codes to be used on family planning clinics claims for drugs used to treat sexually transmitted infections: J3490 (Unclassified drugs) — Use this procedure code for gels and creams (e. 1, in addition to paying for the amount of drug that has been administered to a beneficiary, Medicare Part B also pays for the amount of drug that has been discarded, up to the amount that is indicated on the container or package label. Not Otherwise Classified (NOC) Drugs: Clarification on Required Information. 1, 2025, CMS has established a new procedure code for specialty medical drug Hercessi (trastuzumab-strf). . FDA’s National Drug Code (NDC) Directory contains information about finished drug products, unfinished drugs and compounded Article Text. For NOC codes being reported for services other than Drugs and Biologicals, a concise description of the procedure being completed must be included, otherwise documentation to support the service shall be submitted with the claim submission. g. Prescribed for an approved FDA diagnosis (as listed below): 2. If a claim is submitted with an unlisted drug code (e. Diagnosis codes must be listed to the most specific number. This detailed description can be identified in an HCPCS coding book or in the CMS average sales price (ASP) drug pricing files for the current year, which can be found at cms. Nov 18, 2023 · The drug dose description is 1 mg per unit. 31, 2021, will continue to be reported with codes J3490 and J3590. J3490 is a HCPCS Code. All services through Dec. If the exact drug or biologic amount administered is not a multiple of dosage described in the procedure code description, the provider must round to the next higher unit according to the procedure code description It is important that claims be submitted with the CPT/HCPCS code with the most accurate description when billing for injectable medications that are administered during a patient’s visit. The j3490 cpt code is a generic code used for billing drugs, biological products, and radiopharmaceuticals that do not have a specific HCPCS code. May 3, 2022 · Effective with date of service April 14, 2022, the Medicaid and NC Health Choice programs cover ephedrine hydrochloride injection, for intravenous use (Rezipres®) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs. Subscribe to Codify by AAPC and get the code details in a flash. J3490: This code represents unclassified drugs administered via injection. J3490 is a non-specific code that should be used only when another J-Code does not describe the drug being administered (CMS has not assigned a specific 'J' code to the drug used).  It is extremely important to review the complete long descriptors in the HCPCS code, for the applicable HCPCS codes you can Jun 16, 2020 · Effective with date of service April 7, 2020, the Medicaid and NC Health Choice programs cover meloxicam injection, for intravenous use (Anjeso™) for use in the Physician Administered Drug Program (PADP) when billed with HCPCS code J3490 - Unclassified drugs. See below for Jun 15, 2015 · When billing for unlisted drug codes J3490 and J9999 you must indicate the name, strength, and dosage of the drug in block 19 on the CMS-1500 claim form (or in 2400. HCPCS Code: J3490 Long Description: Unclassified drugs Short Description: Drugs unclassified injection Original information is taken from J3490 page [b]No response, request your opinion on these codes[/b] J8499 Prescription drug, oral, nonchemotherapeutic, NOS J3490 Unclassified drugs I am preferring the J8499, since this is a prescription that [ Read More ] Earlier Prolia injection was billed using HCPCS code either J3490 (Unclassified drugs) or J3590 (Unclassified biologics), but effective from January 1, 2012, a new HCPCS procedure code has been assigned to the drug denosumab (Prolia or Xgeva). CMS has established a permanent procedure code for Neulasta ®. When to use unlisted J-codes: Identify the Correct J-Code: Ensure you’ve selected the most specific J-code that accurately represents the medication Jun 12, 2024 · National Drug Codes Explained. It is important that claims be submitted with the CPT/HCPCS code with the most accurate description when billing for injectable medications that are administered during a patient’s visit. Is J3490 a payable code? NOC coded drugs and biologics (J3490 and J3590) are not separately paid and are considered inclusive of both the acquisition cost and the associated pharmacy overhead or nuclear medicine handling cost. , J3490) and there is no other CPT/HCPCS code for the drug being administered, the provider will need to provide the necessary information on the claim for BCBSTX to properly adjudicate the service line. Oct 1, 2015 · For dates of service on or after 04/01/2016, HCPCS code C9471 should be used to report Hymovis®. Dec 9, 2022 · Unclassified Drug Billing. Mar 1, 2018 · Inappropriately using C9399 when a NOC code (J3490 or J3590) should be used is a billing error and may result in a claims payment error or overpayment. J3490 — Unclassified drugs; J3590 — Unclassified biologicals ; J7999 — Compounded drug, not otherwise classified Search HCPCS Codes 2025 Healthcare Common Procedure Coding System. Nov 10, 2024 · Off-label use: When a drug is used for a purpose not approved by the FDA but deemed medically necessary by the provider. DRUGS BILLED UNDER MISCELLANEOUS CODES J3490, J3590, J9999 OR C9399 PRIOR AUTHORIZATION COVERAGE INFORMATION Note: Drugs with their own HCPC code may not be billed using a The descriptor for HCPCS code J3490 is "unclassified drugs. Z7610 is interchangeable with J3490 when the UnitedHealthcare Commercial Medical Benefit Drug Policy Effective 12/01/2024 HCPCS Code Description J2781 Injection, pegcetacoplan, 1 mg May 2, 2022 · In general, claims with these codes must be submitted with additional qualifying information such as the narrative description reflective of the agent (name of the drug and National Drug Code number), the dose administered, and the method of administration. This code applies only to hospital outpatient departments who bill under the outpatient prospective payment system (OPPS). Regeneron) HCPCS description is: J0178 injection, aflibercept, 1 mg. , metronidazole vaginal gel and miconazole nitrate cream). Member does not have any clinically relevant contraindications, or CMS/Plan exclusions, to the requested The injectable form of heparin substitute, Desirudin, is likely to be coded using HCPCS code J3490 (unspecified drugs) and therefore was not available in Dx. Short Description Drugs unclassified injection Sep 20, 2023 · When billing for unlisted drug codes, include the name, strength, and dosage of the drug. The timeline for adding NOC drugs to the vendor’s drug list and dissemination of corresponding updated information to physicians and carriers will be the same as the timeline for HCPCS code changes listed in CR5079. 00 J9999 55566830101 Degarelix 1 UN 1. This would ensure proper adjudication of your claim. HCPCS code J3490 for Unclassified drugs as maintained by CMS falls under Drugs, Administered by Injection . Drug Name(s): UNCLASSIFIED DRUGS / BIOLOGIC . When billing for a compounded drug, the information must be put into item 19 of the CMS-1500 paper claim form or the electronic equivalent. Important Notes on CPT J3490: Using J3490 requires additional documentation to be submitted with the claim. May 9, 2023 · Lexi-Drugs® as the acceptable compendia based on CMS' Change Request 6191 (Compendia as Authoritative Sources for Use in the Determination of a "Medically Accepted Indication" of Drugs and Biologicals Used Off-Label in an Anti-Cancer Chemotherapeutic Regimen); or C9399 should be used for new drugs and biologicals. CMS has tasked all A/B MACs, including Palmetto GBA, to assist with reducing the national claims payment error rate. The 95 mg dose is billed on one line, with the calculated submitted price for only the amount of the drug given, while the discarded 5 mg must be billed on another line with the JW modifier with the calculated submitted price for only the amount of the drug wasted. Unclassified drugs billed with J3490, J3590, J9999 or C9399* must also include name of drug and dosage to Box 19 of the CMS-1500 paper form or electronic equivalent. When to use unlisted J-codes: You should only use unlisted J-codes when a more specific J-code truly doesn't exist for the medication administered. Learn CPT Code J3490 medicare reimbursement guidelines for drugs with unclassified NDC numbers. If a claim is received for HCPCS J3590 or J3490, it will suspend for review of documentation for coverage and payment determinations. DRUG BRAND NAMES BY CONDITION HCPCS CODE HCPCS DESCRIPTION/GENERIC NAME HEMOPHILIA, VON WILLEBRAND DISEASE, & RELATED BLEEDING DISORDERS Advate J7192 Factor VIII (antihemophilic factor, recombinant) per IU Alphanate J7186 Injection, antihemophilic factor VIII/von Willebrand factor complex (human) per factor VIII i. The program covers drugs that are furnished “incident to” a physician’s service provided that the drugs are medically reasonable and necessary, approved by the Food and Drug Administration (FDA) and are not usually administered by the patients who take them. Jul 1, 2018 · What About Compounded Drugs? Use HCPCS code J3490, which is the code for unclassified drugs, and list each drug and its dosage in the descriptor field. HCPCS Coverage Code: Special coverage instructions apply. This code allows healthcare providers to bill for medications that do not have an established billing structure within the HCPCS framework. HCPCS Code Description: Unclassified drugs When using a drug NOC code (J3490, or J3590) list the name of the drug, the amount of the drug that is administered and wasted if applicable; method of administration in the electronic narrative that is equivalent to line 19 of the CMS 1500 form. Drug Medical Necessity Criteria (dosing limitations, if specified) Conditions Not Covered J3490 Defitelio ® (defibrotide sodium) Treatment of individuals with hepatic veno-occlusive disease (VOD) (sinusoidal obstruction syndrome [SOS]), with renal or pulmonary dysfunction following hematopoietic stem-cell transplantation (HSCT). Services can continue to be reported with C9399, J3490, J3590 and J9999 through March 31, 2024. HCPC: J3490: Short Description: Drugs unclassified injection: Long Description: Unclassified drugs: Pricing indicator: 51: Coverage code: D: ASC payment group code Understanding the J3490 CPT Code Description. Jun 3, 2019 · Effective with date of service 3/8/2019, the North Carolina Medicaid and NC Health Choice programs cover esketamine nasal spray (Spravato™) for use in the Physician Administered Drug Program when billed with HCPCS code J3490 - Unclassified drugs. Mar 8, 2025 · For instance, HCPCS J3490 identifies the type of service or supply used while any of the 229 NDC codes below could be used to specify the exact drug used. This revision is effective 7/1/24. Last updated on June 12, 2024. Strength and dosage 3. mjjfyk foqfce qeswoyzk jyuu zul zomvtk etlqx vihwa bjpf mxsynq cnwmt tnccj zaunu krswm zxrbfwj