Correct coding requires services to be reported with the most specific code available that appropriately describes the service. Not otherwise classified (NOC) HCPCS codes must only be used when a more specific HCPCS or CPT code is not available.
There may be services/procedures performed by physicians/other qualified health care professionals that are not found in the CPT code set. Therefore, several codes have been designated for reporting unlisted procedures/NOC, which can be located in the CPT/HCPCS manual.
Note: Any service received containing a description in the narrative field describing a procedure or service where a valid HCPCS/CPT code exists or that does not include sufficient information about the service being performed may be rejected.
Claims for all drugs and biologicals should be reported using the HCPCS/CPT code which most accurately describes the drug and/or biological. It is also important to make certain the reported units of service for the HCPCS/CPT code are consistent with the quantity of a drug and/or biological.
When the medication administered has not been assigned a HCPCS/CPT code, it is appropriate to use a NOC code based on the descriptor. A description of the drug and/or biological and dosage must be entered in the narrative field of the claim.
For NOC codes being reported for services other than Drugs and Biologicals, a concise description of the procedure being completed must be included, otherwise documentation to support the service shall be submitted with the claim submission.
Use of NOC codes is appropriate if HCPCS Level II code or CPT codes are not available that describes the service.
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
J7999 - Compounded drug, not otherwise classified (paid by invoice except for intravitreal Avastin)
J9999 - Not otherwise classified, antineoplastic drugs
Commonly used when:
Drug/biological does not have a specific CPT or HCPCS code.
Drug/biological is administered by a route other than stated in the code.
Amount of drug or biological is less than the amount, or of a different concentration, than specified in the CPT or HCPCS descriptor.
Remember to confirm that the appropriate HCPCS (specific) and National Drug Code (NDC) is used when submitting a claim.
Note: The units of service for a drug code may not match the available dosage forms. In these cases, the number of units of service billed must be adjusted to match the actual amount provided.
In order to correctly process a claim using NOC codes above, report the following information in block 19 of the CMS 1500 claim form or electronic equivalent:
Name of drug
Strength and dosage (mg, mL, etc.)
Amount wasted (mg, mL, etc.) if applicable
Pricing information for most unlisted drugs may be found on the CMS website at ASP Drug Pricing Files.
Provider billed HCPCS J3590 along with a narrative of mepolizumab 100 mg.
Correct billing: HCPCS J2182 (mepolizumab 1 mg) with a unit of 100.
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