Wiki Billing J3490 in place of S0028 to Medicare

[kathleeng]

What are the thoughts on billing J3490 instead of S0028, when it's to Medicare since Medicare does not recognize S0028. I am in a hematology oncology office and we give it to patient's in chemo treatment. My thoughts are it would just not be billable or reimburseable since there is an available HCPCS code, it is just not payable by Medicare. Or the doctors would need to switch to administering a drug to something that does have a reimburseable code. I have came across mixed views on this since J3490 is payable by Medicare with the appropriate information attached, however it does not seem to be a justifiable reason to use an unlisted code when a HCPCS code does exist. Is it necessary to bill an unlisted code to Medicare when a HCPCS code exists but is not recognizable?

"Appropriate Use of Not Otherwise Classified Codes"
"Correct coding requires services to be reported with the most specific code available which appropriately describes the service. Not Otherwise Classified (NOC) Healthcare Common Procedure Coding System (HCPCS) codes must only be used when a more specific HCPCS or Current Procedural Terminology (CPT) code is not available."
"When the medication administered has not been assigned a HCPCS/CPT code, it is appropriate to use an NOC code based on the descriptor "
found on https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00164100

 

[b.cobuzzi]

I believe you would have no choice but to use the J3490 and include the NDC of the drug so that medicare has the specifics of the drug. But since I do not code and bill for Oncology, I suggest you confirm this in the Oncology Forum where you will find fellow colleagues who work in your specialty, kathleeng.