Billing and coding / HCPCS codes

Healthcare Common Procedure Coding System (HCPCS) codes

  • HCPCS codes include Codes A through V1

  • C-codes (temporary codes for outpatient drugs) and J-codes (HCP-administered drugs) are some of the most commonly used

  • Upon FDA approval, most drugs do not have permanent codes assigned yet; in this case, temporary miscellaneous HCPCS codes are used

C-codes1

  • Temporary pricing codes established by CMS for the Prospective Payment System

  • Valid for all Medicare and some commercial claims for hospital outpatient department services and procedures

C9399

  • Drugs and biologicals that have been approved by the Food and Drug Administration (FDA), but do not yet have a product-specific drug/biological HCPCS assigned

  • Used for hospital billing

Codes are subject to change. Verify current coding prior to any claim submission.

J-codes2

  • Drugs administered via non-oral route, chemotherapy drugs

  • Most infused or injected drugs are classified under J-codes

  • New drugs are assigned an "unclassified" J-code

  • Permanent J-codes are generally assigned 3-6 months after drug approval, at which point the unclassified J-codes should no longer be used

For newly approved (unclassified) drugs

Until a specific code is assigned, one of the following unclassified codes is generally used:

J3490

Unclassified drugs

J3590

Unclassified biologics

J9999

Not otherwise classified, antineoplastic drugs

Codes are subject to change. Verify current coding prior to any claim submission.

Note: How will I know when a permanent J-code is assigned?

Once permanent J-codes are available, the manufacturer will issue information with the new J-code to use.

THIS INFORMATION IS PROVIDED FOR EDUCATIONAL PURPOSES ONLY AND IS NOT A GUARANTEE OF COVERAGE. IT IS THE SOLE RESPONSIBILITY OF THE HEALTH CARE PROVIDER TO SELECT THE PROPER CODES AND ENSURE THE ACCURACY OF ALL STATEMENTS USED IN SEEKING COVERAGE AND REIMBURSEMENT FOR AN INDIVIDUAL PATIENT.

References: 1. Centers for Medicare & Medicaid Services. Accessed June 23, 2020. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM5027.pdf 2. Medical Billing & Coding Certification. Accessed June 23, 2020. https://www.medicalbillingandcoding.org

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