Pharmacy Question for the Week of January 15, 2018

Pharmacy Compliance Question of the Week

Question:

Last week you provided information related to billing Medicare for the mixing of commercial products. What are the billing rules for compounding when the drugs are not a mix of commercially available products?

Answer:

If the hospital is compounding drugs that are not a mixture of commercially available products, but are a different product that has no applicable HCPCS code, then the hospital should report an appropriate unlisted drug code (J9999 or J3490). In these situations, it is not appropriate to bill HCPCS code C9399 (unclassified drug or biological), which is for new drugs and biologicals approved by Food & Drug Administration (FDA) on or after January 1, 2004, but a specific HCPCS code has not been assigned yet.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.