Part B Unlisted Drugs and Biologicals

Published 02/15/2021

Unlisted codes are used when a drug or biological does not have a specific HCPCS code assigned to it. Unlisted codes are not interchangeable, so please be sure you are using the most appropriate code to avoid claim rejections.

  • J3490 — Unclassified drugs
  • J3590 — Unclassified biologicals
  • J7999 — Compounded drug, not otherwise classified
  • J9999 — Not otherwise classified, antineoplastic drugs

These codes are contractor-priced when CMS does not provide pricing on the quarterly Not Otherwise Classified (NOC) pricing file. Palmetto GBA uses the published wholesale acquisition cost (WAC) or invoices to price these codes.

C9399 and ASCs

Ambulatory Surgical Centers (ASCs) can use C9399 to bill for certain unlisted drugs and biologicals. C9399 is also contractor-priced, but is based on 95 percent of the published average wholesale price (AWP).

  • C9399 — Unclassified drugs or biologicals

More information on payment allowances and methodologies for drugs and biologicals that are not included in the ASP Medicare Part B Drug Pricing File or the Not Otherwise Classified (NOC) pricing file can be found in IOM Publication 100-04 Chapter 17 Drugs and Biologicals § 20.1.3 Exceptions to the Average Sales Pricing (ASP) Payment Methodology (PDF, 493 KB)

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