HCPCS code J3490 and NDC number

I am not getting paid when I submit HCPCS code J3490 with the drug name and NDC number. Why?

Answer:
HCPCS code J3490 is a non-specific code that should be used only when another 'J' code does not describe the drug being administered (i.e., CMS has not assigned a specific 'J' code to the drug used). The appropriate 'J' code should be used if one has been assigned to the drug. For the drug with no assigned 'J' code, the name, strength of the drug (if applicable) and the actual dosage administered must be indicated on the CMS-1500 form in Block 19 or Block 24 (listed with the procedure code). If the drug is compounded, the invoice/acquisition cost must be included with the description. This would ensure proper adjudication of your claim for J3490. 

If the name, strength and dosage administered of the drug are not all listed, the claim will be denied for lack of information necessary to process the claim. At present, Railroad Medicare cannot identify a drug by only the NDC number.

How should I submit compounded drugs administered via implanted pump?

Answer:
Submit a single, combined line item for all drugs with HCPCS code J3490. Combine the charges for all drugs.

Electronic claims:

• Indicate the name(s) and dose(s) of each drug being submitted in the documentation record

Paper claims:

• Indicate 'compunded drugs, invoice attached' in Item 19 of the CMS-1500 Claim Form
• Abbreviations are acceptable, but must use industry acceptable abbreviations (e.g., 'MS' for morphine sulphate)
• Billed amount must be the invoice price for the compounded drug(s). To indicate this, we suggest using 'INV' next to the price (e.g., INV $250.00).