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January 2015

HIT drug claims need National Drug Code information for billings

If you’re submitting a home infusion therapy drug claim, please report:

  • The drug’s J code with the NDC dispensed by the pharmacist, plus the appropriate dose form code for the NDC
  • Each NDC separately if more than one container of the same medication is dispensed and the additional containers have a different NDC
  • The NDC using the dispensed quantity with appropriate drug measurement unit. Keep in mind that not all drugs are billed according to the number of vials; some are billed according to the amount of liquid in the vial; e.g., the number of millimeters.

Important information you should know when submitting a HIT drug claim:

  • The dispensed drug quantity may have up to four whole numbers, a decimal point and decimal numbers. For example, XXXX.XX
  • Not all drugs are assigned Health Care Procedure Coding Structure J codes. Some drugs are assigned Q or S codes.
  • J3490 code can only be used when HCPCS hasn’t classified a drug.
  • The date of service is the date the drug is shipped to the patient.
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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
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