Appropriate use of not otherwise classified (NOC) codes
Services must be reported using the most specific CPT or HCPCS code available that accurately describes the service provided. Not Otherwise Classified (NOC) or unlisted CPT/HCPCS codes should only be used when no existing, more specific code is available.
Because some services, procedures, drugs, or biologicals may not yet have an assigned CPT or HCPCS code, unlisted or NOC codes are available for reporting these items when appropriate.
For drugs and biologicals, providers should report the CPT or HCPCS code that most accurately identifies the product administered and ensure that the units billed correspond to the code descriptor. When a specific CPT or HCPCS code has not been assigned, the appropriate NOC code may be reported. In these cases, the claim narrative must include the name of the drug or biological and the total dosage administered.
For services other than drugs and biologicals billed with an NOC code, a concise description of the procedure or service performed must be included in the claim narrative. If the narrative does not adequately describe the service, supporting documentation should be submitted with the initial claim.
The use of NOC codes is appropriate only when no CPT or HCPCS Level II code exists that adequately describes the service provided.
Note: Claims submitted with an NOC code may be rejected if the narrative describes a service for which a valid CPT or HCPCS code already exists, or if the claim lacks sufficient information to identify and support the service being billed.
Unlisted codes for drugs and biologicals
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
J7999 - Compounded drug, not otherwise classified (paid by invoice except for Intravitreal Avastin)
J9999 - Not otherwise classified, antineoplastic drugs
Commonly used when:
- Drug or biological does not have a specific CPT or 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 CPT or HCPCS descriptor
Remember to confirm the proper HCPCS (specific) and National Drug Code (NDC) code is used when submitting a claim.
Note: 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.
NOC drug and biological codes billing
To correctly process a claim using the NOC codes above, report the following information in item 19 of the CMS-1500 claim form or electronic equivalent (loop 2400.SV101-7 in the ANSI 837 claim file):
- Name of drug
- Strength and dosage (mg, mL, etc.)
- Amount wasted (mg, mL, etc.) if applicable
- For more information concerning drug wastage, see Using the JW and JZ modifiers.
- Invoice cost if applicable
Pricing information for most unlisted drugs may be found on the CMS website in the ASP drug pricing file.
For local coverage determinations (LCDs) pertaining to an unlisted drug, refer to the interactive LCD index.
Incorrect use of NOC codes example
Provider billed HCPCS code J3590 along with a narrative of Mepolizumab 100 mg.
Correct billing: The proper billing would be HCPCS code J2182 (Mepolizumab 1 mg) with a unit of 100.
References