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Medicare and other private payors do not recognize S0077 - what code to use?

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okinc10

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Southport, NC
I spoke to customer service at Availity and Medicare a few times about this code. All I have been told is that Medicare doesn't recognize S0077. Has anyone else experienced this issue and what code do you use?
Thank you.
 
S codes were created for private payers and Medicaid. CMS does not recognize S codes and some commercial payers that follow medicare guidelines may not accept them either.

[FONT=&quot]clindamycin phosphate 150MG is on the CMS NOC Drug list, Drugs on that list are to be reported under J3490 - [/FONT][FONT=&quot]Unclassified drugs along with the NDC[/FONT][FONT=&quot]
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S0070

The S0070 is not recognized by Medicare but also the replacement code is not accepted either. It would be great if there was a straight forward reason when researching codes but every case is different.

Thank you all.
 
okinc10 said:
S0070

The S0070 is not recognized by Medicare but also the replacement code is not accepted either. It would be great if there was a straight forward reason when researching codes but every case is different.

Thank you all.
Click to expand...
Reporting NOC code(s)

NOC codes should only be reported for those drugs that do not have a valid HCPCS code which describes the drug being administered.

When appropriate, the NOC code is selected based upon the therapeutic value of the drug (e.g., J8999 Prescription drug, oral, chemotherapeutic, NOS; J3490 Unclassified drugs, etc.).

When billing with an NOC code, include on the claim, the narrative description reflective of the agent and the dose administered.

Source: https://www.cms.gov/medicare-coverage-database/details/article-details

In order to correctly process a claim using NOC codes such as J3490, J3590, and J9999, report the following information in block 19 of the CMS 1500 (02-12) claim form or electronic equivalent:

Name of drug
Dosage (mg, mL, etc.)
Route of administration (IV, IM, SC, PO, etc.)

Source: https://www.novitas-solutions.com/webcenter/portal
 
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