Medicare lcd for j3490. Jul 22, 2025 · This guide will delve into the details of HCPCS Code J3490, including its NDC code association, description, reimbursement rates, and administration guidelines. Sep 23, 2025 · LCDs & Medical Policies A Local Coverage Determination (LCD), as defined in §1869 (f) (2) (B) of the Social Security Act (SSA), is a Medicare Administrative Contractor's (MAC's) determination as to whether a particular item or service is covered on a contractor–wide basis in accordance with section 1862 (a) (1) (A) of the Act. Oct 1, 2015 · Use this page to view details for the Local Coverage Article for Self-Administered Drug Exclusion List:. Apr 22, 2025 · HCPCS Code J3490 is used to bill for unclassified drugs not assigned a specific code. May 9, 2025 · Discover the NDC number for J3490, how to bill it, and what makes this HCPCS code unique in medical billing. For billing of compounded drugs administered via implanted pump, submit a single combined line item for all drugs with HCPCS Code J3490 and bill the combined charges for all drugs. 100-08 Jan 17, 2024 · J3490" is a commonly used HCPCS code for "unclassified drugs. See full list on med. " This code is used when a specific medication does not have a more specific billing code, allowing healthcare providers to report and receive payment for these medications. The JW and JZ modifiers are used in the context of billing for compound medications. This guide helps ensure accurate documentation and payment. Oct 10, 2025 · List of NDC codes used with HCPCS code J3490. Special coverage instructions apply. Learn when to use it, the documentation, and the requirements. Reference the CMS Medicare Program Integrity Manual (Pub. 100-02, Medicare Benefit Policy Manual, section 30. For services performed 8/18/2023 through 1/1/2024, aflibercept HD should be reported using HCPCS codes J3490, J3590 or C9399 for Part A and Part B services. Policy: Medicare may cover denosumab, romosozumab-aqqg, or abaloparatide when provided by an HHA to female beneficiaries who meet the criteria established in Pub. 157, Issued: 06-08-12, Effective: 07-01-12, Implementation: 07-02-12) The Medicare program provides limited benefits for outpatient prescription drugs. Jul 18, 2025 · J3490 is used for billing unclassified drugs when no specific HCPCS code is available. HCPCS Code for Unclassified drugs J3490 HCPCS code J3490 for Unclassified drugs as maintained by CMS falls under Drugs, Administered by Injection . Any miscellaneous HCPCS codes (J3490, J3590 and C9399) billed to Medicare for drugs that are listed in the Coding Table Information below will be denied. The Current Procedural Terminology (CPT®) codes included in this article may be subject to National Correct Coding Initiative (NCCI) edits or Outpatient Prospective Payment System (OPPS) packaging edits. The Current Procedural Terminology (CPT) codes included in this article may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. . 4. The program covers drugs that are furnished “incident to” a physician’s service provided that the drugs are not usually self-administered by the patients who take them. # HCPCS Code J3490: A Comprehensive Overview# HCPCS Code J3490: A Comprehensive Overview ## Definition HCPCS Code J3490 is a procedural code assigned within the Healthcare Common Procedure Coding System, which is used in the United States for healthcare service and supply billing. Specifically, J3490 is categorized as an “unclassified drug” code, serving as a catch-all designation for Oct 1, 2015 · Use this page to view details for the Local Coverage Article for Billing and Coding: Approved Drugs and Biologicals; Includes Cancer Chemotherapeutic Agents. Item 24D or electronic equivalent Enter "J3490" Enter "J3490" Dec 1, 2019 · Article Text Refer to the draft Local Coverage Determination (LCD) L36859-Trigger Point Injections (TPI) reasonable and necessary requirements and frequency limitations. Get the insights needed for smooth reimbursement. Aug 21, 2025 · Use of additional pellets may be paid on appeal if the documentation supports medical necessity as determined by the FDA approved drug label and the service complies with all Medicare requirements as indicated above. Please refer to the NCCI requirements. The Medicare program provides limited benefits for outpatient prescription drugs. 3 and the coverage criteria for the home health benefit established in Pub. noridianmedicare. Unlock the complexities of the j3490 cpt code with our expert coverage and billing guidance. NDC HCPCS Crosswalk for easy coding. Article Guidance Article Text This article contains billing and coding guidelines that complement the Local Coverage Determination (LCD) Drugs and Biologicals, Coverage of, for Label and Off-Label Uses. The table below lists drugs that are not covered by Medicare, the effective date of non-coverage, and the rationale. The program covers drugs that are furnished “incident to” a physician’s service provided that the drugs are not usually self-administered by the patients who take them Mar 31, 2024 · The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Trigger Point Injections L39671. Jun 15, 2015 · For local coverage determinations (LCDs) pertaining to an unlisted drug, refer to the Medicare Policies and Guidelines/LCD's in Find-A-Code. Sep 26, 2025 · Explore Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), and coverage articles for Jurisdiction M Part B with Palmetto GBA. 2 - Determining Self-Administration of Drug or Biological (Rev. The column, “Brand Names,” provides one or more examples but may not include all brand names. Mar 1, 2018 · Use this page to view details for the Local Coverage Article for Billing and Coding: Hospital Outpatient Drugs and Biologicals Under the Outpatient Prospective Payment System (OPPS). At present, Railroad Medicare cannot identify a drug by only the NDC number. Oct 1, 2015 · This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Drugs and Biologicals, Coverage of, for Label and Off-Label Uses. Please refer to the HCPCS code J3490 or J3590 should be used to report aflibercept HD for Part B services. 100-02, Medicare Benefit Policy Manual, section 50. com You may find pricing information for most unlisted drugs on the CMS website. Nov 10, 2024 · Medicare and most other insurers have specific requirements for billing using J3490. Jun 27, 2025 · This article provides an in-depth exploration of cpt code J3490, including its applications, billing best practices, and regulatory considerations. Please note, however, that most unlisted drugs are not covered by an LCD. For local coverage determinations (LCDs) pertaining to an unlisted drug, refer to the LCD interactive index. Jun 1, 2024 · Commercial, Medicare Advantage, and Medicaid plans may prefer other codes for claim submission. This article contains billing and coding guidelines that complement the Local Coverage Determination (LCD) Drugs and Biologicals, Coverage of, for Label and Off-Label Uses. (Please see “Process for Determining Self-Administered Drug Exclusions – Medical Policy Article”). These requirements may include prior authorization or documentation of medical necessity. 50. The options for compound medications include J9035, J3490, J3590, and J7999. 6fh f3ofe mk9ysh wrs35 pog 58nblnbra 7mllvt etnw ql n0