Effective Jan. 15, Novitas to Deny Claims that Use NOC Codes Incorrectly

Novitas Solutions has announced that – effective Jan. 15, 2018 – it will reject Medicare Part B claims that use Not Otherwise Classified (NOC) Healthcare Common Procedure Coding System (HCPCS) codes incorrectly.

Claims for services received on or after Jan. 15, 2018, will be denied if they contain a description in the narrative field describing a procedure or service in cases where a valid HCPCS/CPT code exists, Novitas says.

Claims for all drugs and biologicals should be reported using the HCPCS/CPT code which most accurately describes the drug and/or biological. The reported units of service for the code should be consistent with the quantity of a drug/biological.

When to Use NOC Codes

NOC codes can be used only if an HCPS Level II code or Current Procedural Terminology (CPT) code that describes the service is not available.

Physicians and practices can continue to use NOC codes based on the descriptor for medications that have not been assigned an HCPCS/CPT code. A description of the medication, dosage, and route of administration should be included in the claim's narrative field.

Codes for unclassified or not otherwise classified drugs and biologicals include:

  • J3490 - Unclassified drugs
  • J3590 - Unclassified biologics
  • J9999 - Not otherwise classified, antineoplastic drugs

These codes can be used in cases where the medication doesn't have a specific HCPCS code, is administered by a route other than stated in the code, or has an amount that is less than the amount or of a different concentration than specific in the HCPCS descriptor.

For additional details on the policy, access Novitas' website at www.novitas-solutions.com, access the webpage for Jurisdiction JL, and enter "Appropriate Use of Not Otherwise Classified Codes" in the search field.

Pennsylvania Medical Society (PAMED) members with questions can also contact our Knowledge Center at 855-PAMED4U (855-726-3348) or KnowledgeCenter@pamedsoc.org.

Leave a comment

Return to the art of medicine - MACRA

norcal mutual opioids advertisement
Norcal Mutual

Learn More