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Thread: j3490

  1. #1

    Default j3490

    AAPC: Back to School
    I bill for pain specialist who injects compounded drugs into pain pumps. I have the pharmacy invoices. Do I need to put anything on the cms 1500 to bill the j3490 besides just the code? Are there any remarks that need to be included? I know to bill the DOS w invoice attached.

  2. #2
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    You'll need to check with your Medicare carrier to see exactly what information they need you to put in comments. We deal with two different carriers (Noridian for SD and WPS for Minnesota) and they each want something different. For example, Noridian wants "Compound Rx/size of vial, name/dosage of each drug separated by /, while WPS needs name, total dosage, strength, method of admin(i.e. intrathecal).

    SD Medicaid requires the NDC number, as do most of our commercial carriers.

    Medicare usually pays the refill/pump reprogramming, denies the J3490 for additional information, then we send them the invoice (for some reason they don't want it dropped to paper and the invoice sent in the first time - go figure).

    Good luck!
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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