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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.
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
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