Bill HCPCS code J3490 for Depo-Provera for commercial members

When submitting claims for Depo-Provera^® (medroxyprogesterone) for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members, do the following:

• Bill HCPCS code J3490
• Include clinical documentation
• Include the appropriate National Drug Code, or NDC

Use RC Claim Assist to identify the correct HCPCS code based on the NDC. For more information, see the document titled Using the RC Claim Assist tool: Frequently asked questions for providers.

The Blue Cross or BCN Pharmacy department will look for the information specified above when reviewing claims for Depo-Provera.

Note: Although Depo-Provera has an active HCPCS code, refer to RC Claim Assist to determine how to bill.