Corporate

April 15, 2014 – Updated 07.23.15

Not Otherwise Classified (NOC) Drugs: Clarification on Required Information

Claims for HCPCS codes J9999 (not otherwise classified anti-neoplastic drugs), J3490 (unclassified drugs) and/or J3590 (unclassified biological drugs) must be submitted with additional qualifying information. These claims must include:

  • The name of the drug
  • The National Drug Code (NDC) number
  • The exact dosage given

Claim Submission:

  • For electronic claims, Loop/Element 2400 SV101-7 must be completed for Not Otherwise Classified (NOC) codes. The required documentation (name, NDC and dosage) may be submitted in Loop/Element 2400 SV101-7. If additional space is needed, Loop 2400 NTE 02 may be utilized in addition to SV101-7.
  • For paper claims, the documentation must be in Item 19.

New NOC Code for Compounded Drugs

As a result of Change Request (CR) 9167External PDF, effective for claims with dates of service on and after July 1, 2015, claims for compounded drugs must be submitted using the new compounded drug not otherwise classified (NOC) HCPCS code Q9977.

Using HCPCS code Q9977 is intended to distinguish compounded drugs (which may include biologicals) from the other drug NOC codes listed above.

The same claim submission instructions noted above apply to HCPCS code Q9977.


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