Here’s what you need to know when billing for STELARA^® (ustekinumab)

Effective July 1, 2017, procedure code Q9989 replaces J3490 and J3590 when billing for specialty medical drug STELARA (ustekinumab) for intravenous administration.

The Centers for Medicare & Medicaid Services has established a permanent procedure code for specialty medical drug STELARA^® (ustekinumab) for intravenous administration, effective July 1, 2017.

All services from Nov. 1, 2016, through June 30, 2017, should be reported with code J3490 and J3590. All services performed on and after July 1, 2017, must be reported with Q9989.

Prior authorization is still required for the specialty medical drug STELARA (ustekinumab) for intravenous administration when reported with the new procedure code Q9989, unless the group has opted out of the commercial Specialty Pharmacy Prior Authorization Program.

The NDC number for STELARA is 57894-0054-27.

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.