## **What is the HCPCS code J3490 for?**
The HCPCS code J3490 is meant to designate the use of unclassified drugs. This is the HCPCS code that you must use if the drug administered to a patient (oral drugs, injectable drugs, drugs given through other non-oral methods) doesn't have a specific HCPCS code. If you're using a newly FDA-approved drug, compounded medications, or off-label uses that lack established coding, then this HCPCS code is the best choice to use.
Please do not use HCPCS code C9339, as it is intended for new and unclassified drugs and biologicals introduced on or after January 1, 2004. After 2004, drugs and biologicals that don't have specific HCPCS codes must be billed with a NOC code: J3490 for unclassified drugs (the valid HCPCS code you should use, in the context of this guide), J3590 for biologicals.
## **Documentation requirements for HCPCS code J3490**
As with any procedure, especially involving the administration of drugs to patients, it's important to document the following before you file for a claim that includes this code:
- The full name of the personnel who administered the unclassified drug + their credentials
- The name and address of the facility where the unclassified drug was administered
- Method of administering the drug (please indicate the full procedure)
- The name of the unclassified drug, including its National Drug Code (NDC)
- The medical necessity of using said unclassified drug
- The full name of the patient
- The date and time of the drug administration
- Patient medical records showing information that supports the decision to use said drug
- Any relevant test results related to the problems that the drug will address
- The exact dosage and route
## **Billing requirements for J3490**
Besides the documentation requirements above and the appropriate HCPCS code (J3490), please make sure to include the following:
- The corresponding ICD-10-CM diagnosis code related to the problem the unclassified drug is meant to address
- The appropriate revenue codes or service codes (e.g., code for hospital outpatient, place uunder the correct revenue code for drugs)
- Use either of two modifiers: JW if there's unused medication in a vial (wastage), or JZ if there's no unused medication.
- CPT code 96365 if you administered the injection via IV, or 96372 if you administered it via IM
Please make sure to follow CMS/Medicare claims processing manual billing guidelines or Medicaid services billing guidelines to reduce the chances of your claim being rejected.
Do note that, for C9399, drugs and biologicals appropriately billed using it are separately payable and are priced by this A/B MAC using Average Wholesale Price (AWP) and CMS pricing methodology. However, for J3490 and J3590, that's not the case. They are not separately paid and are considered inclusive of both the acquisition cost and the associated pharmacy overhead or nuclear medicine handling cost.
## **Other similar codes**
- **C9399** - Unclassified drugs or biologicals
- **J3590** - Unclassified biologics
- **J7999** - Compounded drug, not otherwise classified
- **J9999** - Not otherwise classified, antineoplastic drugs
- **A9150** - Non-prescription drugs
Frequently asked questions
