Claims reporting HCPCS Code C9399 - Unclassified Drugs or Biologicals

Published 02/08/2018

The Federal Drug Administration (FDA) approved a number of chemotherapy drugs late last year and specific coding is not yet available. The HCPCS code C9399 - Unclassified Drugs or Biologicals, may be reported. Claims reporting HCPCS code C9399 will be returned to the provider (RTP) to request supporting medical documentation be faxed to the Palmetto GBA Pricing Department. Providers may notate in the Remarks field the date the documents were faxed when returning the claim to the claims processing system. These claims will then be held in the status/location S MPRC3 while the documents are being reviewed. If you have multiple dates of service, it is not necessary to send a separate set of documentation for each claim. You may submit a coversheet, reference each claim and send the documentation in once for the drug review and pricing application. 

Please note that if a claim utilizing HCPCS code C9399 is for Daratumumab (Darzalex), the required documentation must indicate that the patient has:

  • Received at least three prior lines of therapy including a proteasome inhibitor (PI)
  • Received an immunomodulatory agent or (those who are double-refractory) a PI and an immunomodulatory agent
  • Been pre-medicated with corticosteroids, antipyretics (e.g. Acetaminophen) and antihistamines (e.g. Diphenhydramine) prior to the treatment of Daratumumab

If you have any further questions please contact our Provider Contact Center (PCC).