Unlisted Codes for Drugs and Biologicals (J3490, J3590 and J9999)

An unlisted code should only be used when no other code adequately describes the service. They are commonly used when the drug/biological does not have a specific HCPCS code, when it is administered by a route other than the route stated in the description of a specific HCPCS code, and/or the amount of the drug/biological is less than the amount of, or a different concentration of, what is specified in the HCPCS code description.

• J3490 ‒ Unclassified drugs
• J3590 ‒ Unclassified biologics
• J9999 ‒ Not otherwise classified, antineoplastic drugs

Unlisted codes J3490, J3590 and J9999 billed to the Part B MAC are priced manually. When billing unlisted codes, the unit of service equals one (1), and the following details must be entered into in Item 19 of the CMS-1500 or electronic claim equivalent:

• Name of the drug
• Dose administered (mg, cc, etc.)
• Route of administration (IV, IM, SC, PO, etc.)
• The invoice price (for new drugs if the WAC is unavailable, or for compounded drugs)

Posted 3/26/2024