Update: Not Otherwise Classified J-Codes

In October 2008, BCBSIL posted Guidelines for Billing Unlisted J Codes on the Provider Web site and later ran an article in the December Blue Review in reference to billing unclassified drugs/injections under “Not Otherwise Classified (NOC)” drug/injection codes (e.g. J3490, J3590, etc.) using the National Drug Code (NDC) number.

We advised physicians and providers that effective Feb. 1, 2009, BCBSIL would begin checking NDC numbers against the Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPSC) procedure codes as published by the American Medical Association (AMA).

In order to properly adjudicate claims and reimburse physicians and providers for these procedure codes, BCBSIL continues to enhance its capabilities for NDC processing to reduce underpayments and overpayments to our physicians and providers. We are currently using average wholesale pricing supplied by Prime Therapeutics to properly adjudicate unclassified drugs/injections.

It is important that physicians and providers supply the necessary information for BCBSIL to properly adjudicate and reimburse claims for these procedures. Our claims processing units may have called your office requesting additional information regarding these unclassified drugs/injections when billed by your physicians. This is done in an effort to properly adjudicate the claim without having to request additional information in writing, which could delay the processing of the claim.

In an effort to minimize these calls to your office, please be sure to include the following information on your claims when billing for unlisted drugs/injections:

  • NDC Number
  • Drug Name
  • Dosage administered (e.g. 5 mg, 10 mg, etc.)
  • Include how the number of units being billed on the claim is being administered (e.g. 5 mg = 1 unit, 10 mg = 5 units, etc.)
  • Strength of drug administered (e.g. 25 mg/ml, 10 mg/10 ml, etc.)
  • Single dose vial or Multi-dose vial

Please Note: An NDC number will be reimbursed for a maximum of two years after it becomes obsolete.

If you have any questions, you may contact our Provider Telecommunication Center at (800) 972-8088 to speak with a Customer Advocate for assistance.