April 15, 2014 – Updated 08.14.20
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 9486, effective for claims with dates of service on and after January 1, 2016, claims for compounded drugs must be submitted using the new compounded drug not otherwise classified (NOC) HCPCS code J7999. For dates of services on or after January 1, 2015 through, December 31, 2015, the compounded drug NOC HCPCS code Q9977 must be submitted. The same claim submission instructions noted above apply.
This code(s) is intended to distinguish compounded drugs (which may include biologicals) from the other drug NOC codes listed above.