Corporate

January 17, 2017 - Revised: 08.24.18

Coding to describe STELARA® (ustekinumab) for Intravenous Administration

Effective January 1, 2017, CMS modified HCPCS code J3357 to be specific to the subcutaneously administered of STELARA® (ustekinumab)  for subcutaneous injection and is NOT appropriate for reimbursement of intravenous administration as this would result in overpayment of the drug.

Claims for IV administration of STELARA® (ustekinumab) PRIOR to 01/01/2017 should be submitted with the appropriate miscellanous code, J3490-UNCLASIFIED DRUG or J3590-UNCLASSIFIED BIOLOGIC with the following information added to Loop/Element 2400 in the electronic file or Field 19 of CMS’ 1500 paper claim form:

  • Name of the Drug
  • The Exact Dose Administered
  • The NDC Number of the Medication

Covered indications: Crohn’s disease K50.00; K50.01; K50.011; K50.012; K50.013; K50.014; K50.018; K50.10; K50.11; K50.111; K50.112; K50.113; K50.114; K50.118; K50.80; K50.81; K50.811; K50.812; K50.813; K50.814; K50.818

REF: CMS’ 2017  HCPCS CODE BOOK

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