In this Special Bulletin of Pharmacy Revenue Cycle News, we are answering questions sent to us from Michael from a health-system in Indiana.
Michael writes, “When do you use HCPCS code C9399 versus J3490 for unclassified drugs?”
Response: We recommend using C9399 instead of J3490 or J3590 because the C9399 code has an OPPS status indicator of “A” and is reimbursed for outpatients at 95% of AWP. The J3490 and J3590 codes have a status indicator of “N” meaning they are covered but you won’t receive any separate payment. So you definitely want to use C9399 when the drug is eligible. This may not apply in all locations, but does apply for hospital outpatient departments. We recommend always reporting C9399 in revenue code 636 unless a payer provides different instructions.
On Michael’s second question about remdesivir: “What is the best practice for billing Remdesivir (recently FDA approved but no HCPCS that I can find), should J3490 be used?”
Response: We definitely recommend C9399 for remdesivir now that it has FDA approval and we’ve added it to our C9399 tool. For inpatients, the charges will contribute to outlier payment calculation or inpatient carve outs depending on your individual contract language. If the drug is used on outpatients in the future it will result in extra payment with the C9399 code.
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Thanks again for the dialogue!!
Agatha & Maxie