What is the CPT code J3490 used for?
Asked by: Prof. Angus Wisoky Sr. | Last update: August 19, 2025Score: 4.8/5 (35 votes)
What is the CPT code for semaglutide Injection?
The CPT code for injectable semaglutide is J3490. J3490 is also the appropriate CPT code for billing semaglutide injections in a provider's office. This code falls under the broader J3490-J9999 category for "Unclassified Drugs."
What does "unclassified drug" mean?
The term unclassified is used to describe a drug that does not have a specific designated code in the Healthcare Common Procedure Coding System (HCPCS) or the Current Procedural Terminology (CPT) manual.
What drug is J3490?
Famotidine Injection (Pepcid®) HCPCS Code J3490: Billing Guidelines. Effective with date of service Jan.
What is the J code for Mounjaro?
Summary of Changes: Under Excluded CPT/HCPCS Codes added: Mounjaro™ (Tirzepatide) - C9399, J3490, J3590 effective 11/19/2022.
What is a CPT Code in Medical Billing?
What is CPT code J3490?
Rezafungin for Injection, for Intravenous Use (Rezzayo™) HCPCS Code J3490 - Unclassified Drugs: Billing Guidelines.
What diagnosis code will cover Mounjaro?
Primary Diagnosis: The primary diagnosis for this patient is Type 2 diabetes mellitus, which falls under the ICD-10 code E11. 9 (Type 2 diabetes without complications). Adding this code validates the medical necessity for blood glucose management with Mounjaro.
What is the J code for Lupron?
J9217 Leuprolide Acetate - CanMED: HCPCS.
Can J3490 be billed for lidocaine?
To bill for lidocaine, report J3490 [Un- classified drugs]. Lidocaine would be in- cluded as a supply with code 58999 and therefore not separately billable.
What are J codes in medical billing?
J-codes, part of HCPCS Level II, are alpha-numeric codes used only for non-oral medications. The medicines they are referring to, like chemotherapy, inhalation products, and immunosuppressant drugs, are part of J-codes for drugs.
What does unclassified mean in medical terms?
Anything that's unclassified hasn't been sorted or organized into a certain category. If your symptoms can't be identified as a specific illness, your doctor may describe you as having an unclassified condition. Science is all about classifying things, putting them into classes or groups based on common traits.
What are 3 drug classifications?
- depressants – slow down the function of the central nervous system.
- hallucinogens – affect your senses and change the way you see, hear, taste, smell or feel things.
- stimulants – speed up the function of the central nervous system.
What diagnosis will cover semaglutide?
As many as 3.6 million people are most likely to qualify. This assumes plans only allow people with obesity who have already had a heart attack or stroke, or gotten diagnosed with coronary artery disease or angina, to get coverage for semaglutide injections, the study suggests.
How do you qualify for semaglutide injections?
- Have a body mass index (BMI) of 27kg/m2 or greater and at least one weight-related condition, such as high blood pressure, Type 2 diabetes or high cholesterol.
- Have a BMI of 30kg/m2 or greater.
What diagnosis code is needed for Ozempic?
ICD-10 Code E11. 9: This code represents “Type 2 diabetes mellitus without complications.” This diagnosis supports the medical necessity of a GLP-1 agonist like Ozempic, especially in cases where other medications have not provided adequate blood glucose control.
When to use J3490?
Not Otherwise Classified (NOC) codes (eg J3490, J3590, J7999) should only be reported for those drugs that do not have a valid HCPCS code which describes the drug being administered or per payer policy. IReport name of drug, dosage and route of administration in item 19 of the CMS-1500 or EDI equivalent.
How much does Rezzayo cost?
Rezzayo (rezafungin) is a member of the echinocandins drug class and is commonly used for Candidemia, and Systemic Candidiasis. The cost for Rezzayo 200 mg intravenous powder for injection is around $2,124 for a supply of 1 powder for injection, depending on the pharmacy you visit.
What is procedure code 96372 used for?
CPT® code 96372: Injection of drug/substance under skin or into muscle | American Medical Association.
How do you bill a lupron Injection?
Effective January 1, 2023, CMS has assigned a permanent J-Code for Cipla's LEUPROLIDE ACETATE INJECTION DEPOT. Effective January 1, 2023, claims should be submitted using J1954 Injection, leuprolide acetate for depot suspension (lutrate), 7.5 mg.
What is the J code for estradiol Injection?
J1380 Estradiol Valerate - CanMED: HCPCS.
How to get Mounjaro covered?
- Talk to your medical team. ...
- Review your insurance plan's formulary. ...
- Obtain a prior authorization if required. ...
- Request an appeal if necessary.
What diagnosis is approved for Mounjaro?
Mounjaro (trizepatide) is an injectable medication that you take once a week. It's FDA-approved to manage blood sugar in people with type 2 diabetes, but your healthcare provider may also offer this treatment to support weight management if you live with obesity.
Why does Mounjaro need prior authorization?
All Mounjaro prior authorization requests include a section for 'Clinical Criteria', which might also be referred to as Diagnosis or Medical Information. The goal of this information is to prove that you meet the clinical (medical) necessity requirements for Mounjaro.