Update: Not Otherwise Classified J-Codes

In November 2008, Blue Cross and Blue Shield of Texas (BCBSTX) published an article (Are You a Provider Billing Unlisted J-Codes?) via the BCBSTX Provider Web site and later in the Blue Review during December 2008 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 February 1, 2009 BCBSTX 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, BCBSTX 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 BCBSTX 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 (2) years after it becomes obsolete.

If you have any questions, you may contact our Provider Customer Service Department at (800) 451-0287 to speak with a Customer Advocate for assistance.