- Change to Roster Claims Information Entry in the Fiscal Intermediary Standard System Direct Data Entry
- Drugs and Biologicals - Coverage and Billing
- Medicare Part B Drug Coverage
- Covered Medicare Part B Drugs/Biologicals
- Self-Administered Drug Exclusion
- Medicare Part B General Billing
- Discarded Drugs/Wastage and JW, JZ Modifier
- Chemotherapy General Infusion Information
- Monoclonal Antibodies in Treatment of Alzheimer’s Disease - Medicare Advantage Plan Responsibility
- Reimbursement for Pre-exposure Prophylaxis Using Antiretroviral Therapy to Prevent Human Immunodeficiency Virus Infection
- Unlisted Codes for Drugs and Biologicals (J3490, J3590 and J9999)
- Compound Drugs
- Patient-Supplied or Free-of-Charge Drugs
- Prolonged Drug and Biological Infusions Using an External Pump
- Coding for Sinuva™ Claims
- Radiopharmaceutical Reimbursement
- Dermal Injections for Treatment of Facial Lipodystrophy Syndrome
- Factor VIII Billing
- Intravitreal Beovu (Brolucizumab-dbl) Billing
- Proper Billing for LEQVIO® HCPCS Code J1306
- Erythropoiesis Stimulating Agents: Clinical Indications and Coverage Criteria Overview
- Proper Billing for TEZSPIRE™ HCPCS Code J2356
- Proper Billing Units for HCPCS Code J7320
- Providers Performing Facet Joint Injections (CPT Code 64476)
- Skin Substitutes
- Vaccines
- Related Content
Unlisted Codes for Drugs and Biologicals (J3490, J3590 and J9999)
An unlisted code should only be used when no other code adequately describes the service. They are commonly used when the drug/biological does not have a specific HCPCS code, when it is administered by a route other than the route stated in the description of a specific HCPCS code, and/or the amount of the drug/biological is less than the amount of, or a different concentration of, what is specified in the HCPCS code description.
- J3490 ‒ Unclassified drugs
- J3590 ‒ Unclassified biologics
- J9999 ‒ Not otherwise classified, antineoplastic drugs
Unlisted codes J3490, J3590 and J9999 billed to the Part B MAC are priced manually. When billing unlisted codes, the unit of service equals one (1), and the following details must be entered into in Item 19 of the CMS-1500 or electronic claim equivalent:
- Name of the drug
- Dose administered (mg, cc, etc.)
- Route of administration (IV, IM, SC, PO, etc.)
- The invoice price (for new drugs if the WAC is unavailable, or for compounded drugs)
Posted 3/26/2024