Yes, 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 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)

View Billing and Coding: Drugs and Biologicals A52855 for additional details.