by Christine Woolstenhulme, QCC, QMCS, CPC, CMRS
June 15th, 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.SV101-7 in theANSI 837 claim file). It is extremely important to review the complete long descriptors in the HCPCS code, for the applicable HCPCS codes you can find pricing for most unlisted drugs on the CMS website at: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/index.html .
- The National Drug Code (NDC)
- The quantity of the drug that was administered (expressed in the unit of measure applicable to the drug or biological); and
- The date the drug was furnished to the beneficiary