Wednesday, June 8, 2016

Reporting NDC code for Unclassified drugs

Unclassified Drugs

An unclassified drug is defined as a drug that does not have a specific, designated HCPCS/CPT code. Unclassified HCPCS/CPT codes should only be used when a specific HCPCS/CPT code is not available for the drug being billed. Claims being sumitted with an unspecified HCPCS/CPT code when there is a designated HCPCS/CPT code for that drug will result in a denial of payment.
The following guidelines are for providers who submit unclassifed drug codes on the CMS-1500 claim form or its electronic equivalent:
Apply the appropriate unclassified drug HCPCS/CPT (e.g. J3490, J3590, J9999, etc) that is aligned with the billed NDC Code. The following identifies the list of unclassified drug HCPCS/CPT codes:

• 90399 – Unlisted Immune Globulin

• 90749 – Unlisted Vaccine/Toxoid

• A9699 – Radiopharmaceutical, Therapeutic, Not Otherwise Classified

• D9630 – Other Drugs and/or Medicaments, by report

• J1599 – Injection, Immune Globulin, Intravenous, Nonlyophilized (e.g., liquid), Not Otherwise Specified, 500 mg

• J3490 – Unclassified Drugs

• J3590 – Unclassified Biologics

• J7199 – Hemophilia Clotting Factor, Not Otherwise Classified

• J7599 - Immunosuppressive Drug, Not Otherwise Classified

• J7699 – NOC Drugs, Inhalation Solution Administered Through DME

• J7799 - NOC Drugs, Other Than Inhalation Drugs, Administered Through DME

• J8498 – Antimetic Drug, Rectal/Suppository, Not Otherwise Specified

• J8499 – Prescription Drug, Oral, Nonchemotherapeutic, NOS

• J8597 – Antiemetic Drug, Oral, Not Otherwise Specified

• J8999 – Prescription Drug, Oral, Chemotherapeutic, NOS

• J9999 - Not Otherwise Classified, Antineoplastic Drugs

• Q0181 - Unspecified oral dosage form, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment, not to exceed a 48-hour dosage regimen

• Q2039 - Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

• Q4082 - Drug or biological, not otherwise classified, Part B drug Competitive Acquisition Program (CAP)

• S5000 – Prescription Drug, Generic

• S5001 – Prescription Drug, Brand

• Q9977- Compounded Drug, Not Otherwise Classsified

The following are examples:

Unclassified Drug HCPCS    Unclassified HCPCS Description    NDC Code      NDC Description

J9999      Not otherwise classified, antineoplastic drugs   00085-1388-01   Sylatron 296MCG KIT

J3490           Unclassified drugs            38779-1756-00     FentaNYL Citrate POWD

J3590            Unclassified biologics       66658-0234-28      Kineret 100MG/0.67ML SOLN

J8499       Prescription drug, oral, non-chemotherapeutic, Not otherwise Specified   51655-0113-25         Benadryl 25MG CAPS

J8999       Prescription drug, oral, chemotherapeutic, Not otherwise Specified         59572-0410-00         Revlimid 10MG Caps

J7599      Immunosuppressive drug, not otherwise classified   00004-0298-09   CellCept Intravenous

J7699       NOC drugs, inhalation solution administered through DME.      00487-9301-33    Sodium Chloride 0.9% NEBU

A9699      Radiopharmaceutical, therapeutic, not otherwise classified       50419-0208-01    Xofigo 27 MCCI/ML SOLN

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