Last Modified: 5/23/2024
Location: FL, PR, USVI
Business: Part A
Correct coding requires services to be reported with the most specific code available that appropriately describes the service. Not otherwise classified (NOC) HCPCS or CPT codes must only be used when a more specific HCPCS or CPT code is not available.
There may be services or procedures performed by physicians or other qualified health care professionals not found in the CPT or HCPCS code sets. Therefore, several codes have been designated for reporting unlisted or NOC procedures, which can be found in the CPT and HCPCS code manuals.
Claims for all drugs and biologicals should be reported using the CPT or HCPCS code which most accurately describes the drug or biological. It is also important to make certain the reported units of service for the CPT or HCPCS code are consistent with the description of a drug or biological.
When the medication administered has not been assigned a CPT or HCPCS code, it is appropriate to use a NOC code based on the descriptor. A description of the drug or biological and dosage must be entered in the narrative field of the claim.
Use of NOC codes is appropriate if HCPCS Level II codes or CPT codes are not available that describes the service.
Note: Any claim received for a service having a description in the narrative field for a procedure or service where a valid CPT or HCPCS code exists will be returned to provider (RTPd).
Unlisted codes are commonly used when the:
• Drug or biological does not have a specific HCPCS code
• Drug or biological is administered by a route other than stated in the code
• Amount of drug or biological is less than the amount, or of a different concentration, than specified in the HCPCS descriptor
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". This code applies only to hospital outpatient departments who bill under the Outpatient Prospective Payment System (OPPS)
For hospitals, if two or more drugs or biologicals are mixed together to facilitate administration, the correct HCPCS code should be reported separately for each product used in the care of the patient.
If the hospital is compounding drugs that are not a mixture of commercially available products but are a different product that had no applicable HCPCS code, report an unlisted drug code.
You are encouraged to assure that the appropriate specific HCPCS or National Drug Code (NDC) code is used when billing Medicare for drugs. You are reminded that the units of service for a drug code may not match the available dosage forms. In these cases, the number of units of service billed must be adjusted to match the actual amount provided.
When HCPCS code C9399 is reported, remarks must include:
• Name of drug
• Strength and dosage (mg, mL, etc.)
• Amount wasted (mg, mL, etc.) if applicable
Additionally, when reporting HCPCS code C9399 on bill type 12X or 13X, include the following on the claim:
• NDC
• Quantity of the drug that was administered
• Quantity qualifier:
• F2 - international unit
• GR - gram
• ML - milliliter
• UN - units
Provider billed C9399 along with Remarks indicating Daratumumab, 100 milligrams (mg) injection, given via Intravenous (IV).
Correct billing: HCPCS J9145 (injection, daratumumab, 10mg) with 10 units (10mgs X 10 units = 100 ml injected)
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