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Last Modified: 12/5/2018 Location: FL, PR, USVI Business: Part B

Billing unlisted drug procedure codes J3490 and J9999

Procedure codes J3490 and J9999 are unlisted codes for injection services.
J3490 - Unclassified drugs
J9999 - Not otherwise classified, antineoplastic drugs
When billing for these codes, the provider 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 the ANSI 837 claim file).
Pricing information for most unlisted drugs may be found on the Centers for Medicare & Medicaid Services (CMS) website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/index.html external link.
For local coverage determinations (LCDs) pertaining to an unlisted drug, refer to the LCD lookup tool. Please note, however, that most unlisted drugs are not covered by an LCD.
Source: CMS IOM Pub 100-04, Ch. 17
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