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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So as to get the most extreme measure of cash on the cases being submitted there should be follow-up on the cases. This as a rule is the place in-house billing misses the mark, contingent upon the measure of staff that is a piece of the division, guarantee accommodation and installment posting become the needs.CPT CODE 99203