2025 HCPCS code J3490

This HCPCS code reports the supply of a drug lacking a specific code.

Follow all payer-specific guidelines.Accurate reporting of NDC, drug name, dosage, and quantity is critical. Consult with the payer's medical policy and billing guidelines for specific requirements.

Modifiers may apply depending on the circumstances of administration; review payer-specific guidelines for allowed modifiers.

Medical necessity must be established for the administered drug.The documentation should justify the use of the drug and its administration in the specific clinical context. This may require supporting clinical information.

The provider administering the drug is responsible for reporting this code.Complete drug identification is crucial.

IMPORTANT Depending on the drug and payer requirements, J9999 (unclassified antineoplastic drug) or J3590 (unclassified biologics) might be used as alternatives.

In simple words: This code is for medications without a specific billing code.The doctor must provide details like the drug's name, dosage, and strength.This only covers the cost of the drug, not the administration.

HCPCS code J3490, "Unclassified drugs," is used to report the supply of a drug when no other specific HCPCS code exists.The provider must identify the drug completely, including its National Drug Code (NDC) number, name, dosage and strength, doses per vial (if applicable), and amount per unit.This code only represents the drug itself, not its administration.Additional coding may be necessary to report administration, depending on payer guidelines.Alternatives include J9999 (antineoplastic drug) or J3590 (unclassified biologics), depending on the drug's nature.Use this code only when no other specific medication code applies.

Example 1: A patient receives an off-label intravenous medication not listed in the HCPCS codebook. The physician uses J3490 to bill for the drug, providing detailed information about the medication including NDC number, name, dosage, strength and administration method., A patient requires a compounded medication prepared by a pharmacy. Since there isn't a specific code for the exact mixture, the physician uses J3490, documenting all components and their dosages, and indicating the compounding process., In an emergency situation, a physician administers an experimental drug not yet assigned a HCPCS code. J3490 is used with comprehensive documentation including research study identification.

Complete and accurate documentation is essential, including the drug's NDC number, name, dosage, strength, amount administered, route of administration, and any other relevant details. The documentation should support medical necessity.

** The use of J3490 necessitates careful documentation to avoid claim denials.Always consult current payer guidelines and coding resources.Accurate reporting of the NDC is critical for accurate reimbursement.

  • Payment Status: Active
  • Modifier TC rule: A technical component modifier (TC) likely does not apply directly to J3490 as it represents the drug itself, not its administration.However, if administration is separately billed, a TC modifier might be relevant for that administration code.
  • Fee Schedule : Fee schedules vary widely depending on the payer and the specific drug. Reimbursement rates are not standardized for J3490, making payer-specific research critical.
  • Specialties:All specialties may utilize this code when administering unclassified drugs.
  • Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center, other locations where drugs are administered.
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