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 will 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.
Use of NOC codes is appropriate if HCPCS Level II code or CPT codes are not available that describes the service.
J3490 - Unclassified drugs
J3590 - Unclassified biologics
J9999 - Not otherwise classified, antineoplastic drugs
Commonly used when:
Drug/biological does not have a specific 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 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 such as J3490, J3590, and J9999, report the following information in block 19 of the CMS 1500 (02-12) claim form or electronic equivalent:
Name of drug
Dosage (mg, mL, etc.)
Route of administration (IV, IM, SC, PO, etc.)
The provider administered 1 mL of Bupivacaine intravenously.
Report name of the drug, dosage and route of administration in item 19 or the electronic equivalent.
Provider billed HCPCS J3590 along with a narrative of mepolizumab 100 mg.
Correct billing: HCPCS J2182 (mepolizumab 1 mg) with a unit of 100.