J1050 vs J3490

Najwa

Networker
Local Chapter Officer
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84
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Gainesville (NCF) Florida
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Hello my coding peeps.
Hello my coding peeps. Have any of you heard of BCBS denying claims for J1050 Depo Provera wanting you to bill J3490 Unlisteed drug because of NDC compatiability. This is what they are citing.

They are citing this source.

RJ Health does not crosswalk the medroxyprogesterone NDCs indicated for contraception to J1050 based on a decision made in 2014. This NDC is indicated for the prevention of pregnancy. The excerpt from the RJ Health newsletter is below. Additionally, RJ Health contacted CMS asking the intent of J1050 and received the following response: “Please note that the NDC in our crosswalk file is indicated only for adjunctive therapy and palliative treatment of inoperable, recurrent, and metastatic endometrial or renal carcinoma. CMS does not include contraceptive products when calculating payment limits for HCPCS code J1050.”

NDC Crosswalk Change for J1050:
Effective with our 8/1/14 update we have removed all Depo-Provera 150 mg products and have moved them to NDC Code J3490 Unclassified drugs. This move was based on the fact that the intent for code J1050 Injection, medroxyprogesterone acetate, 1 mg was not to include the contraceptive products but rather for Depo-Provera 400 mg products. This decision to move them to J3490 was also based on provider feedback of significant under reimbursement for the 150 mg formulation because the cost is much higher than the 400 mg formulation and also due to the fact that the contraceptive products are not covered under Medicare and are not included in the CMS NDC crosswalk. Due to these factors we thought it appropriate to remove the 150 mg products from J1050.
 

SharonCollachi

True Blue
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1,201
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Clovis, CA
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They have given you the resolution. They state that the code for depo-provera is not intended for contraception, so use the unlisted code.
 
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5
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Billing with an unlisted code when there is a code that is specified as well as the specified code being listed in our contract would not be correct coding.
 
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5
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We are having the same issue with BCN and I've tried billing with the J3490 and it's denied as well.... anyone get any answers?
 

SharonCollachi

True Blue
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1,201
Location
Clovis, CA
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It looks like Florida Blue has moved depo-provera to the pharmacy benefit for a lot of plans. This usually means you cannot "buy and bill", but have to order it with a prescription for the patient.

Billing Guide (jump to the "Billing Drug Services on a Professional Claim" section): https://www.floridablue.com/sites/f...ocs/Billing Guidelines Section 02 08 2019.pdf

Medication Guide for the different Florida Blue Plans, to see if depo-provera is now a pharmacy benefit: https://www.floridablue.com/provide.../SA_Providers/SA_Pharmacy/SA_MedicationGuides
 
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I'm getting these denials from BCN and Molina in which they only deny J1050 with certain NDC's as they've paid when using different stock/NDC on a different dos.... I've also tried billing J3490 and that wasn't paid either.... I'm at a dead end with this... any help would be greatly appreciated. Thank you
 
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