# J1050 vs J3490



## Najwa (Dec 17, 2019)

Hello my coding peeps.
Hello my coding peeps. Have any of you heard of BCBS denying claims for J1050 Depo Provera wanting you to bill J3490 Unlisteed drug because of NDC compatiability. This is what they are citing.

They are citing this source.

RJ Health does not crosswalk the medroxyprogesterone NDCs indicated for contraception to J1050 based on a decision made in 2014. This NDC is indicated for the prevention of pregnancy. The excerpt from the RJ Health newsletter is below. Additionally, RJ Health contacted CMS asking the intent of J1050 and received the following response: “Please note that the NDC in our crosswalk file is indicated only for adjunctive therapy and palliative treatment of inoperable, recurrent, and metastatic endometrial or renal carcinoma. CMS does not include contraceptive products when calculating payment limits for HCPCS code J1050.”

NDC Crosswalk Change for J1050:
Effective with our 8/1/14 update we have removed all Depo-Provera 150 mg products and have moved them to NDC Code J3490 Unclassified drugs. This move was based on the fact that the intent for code J1050 Injection, medroxyprogesterone acetate, 1 mg was not to include the contraceptive products but rather for Depo-Provera 400 mg products. This decision to move them to J3490 was also based on provider feedback of significant under reimbursement for the 150 mg formulation because the cost is much higher than the 400 mg formulation and also due to the fact that the contraceptive products are not covered under Medicare and are not included in the CMS NDC crosswalk. Due to these factors we thought it appropriate to remove the 150 mg products from J1050.


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## faraasha624 (Sep 21, 2020)

We are having the same issue with Florida Blue, have you seen any resolution to this issue?


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## SharonCollachi (Sep 21, 2020)

They have given you the resolution. They state that the code for depo-provera is not intended for contraception, so use the unlisted code.


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## faraasha624 (Sep 21, 2020)

Billing with an unlisted code when there is a code that is specified as well as the specified code being listed in our contract would not be correct coding.


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## SharonCollachi (Sep 21, 2020)

Then file a contract dispute.  They have given you their answer.


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## faraasha624 (Sep 21, 2020)

@Najwa, were you able to get resolution with this issue on your end?


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## Sugarfoots2 (Sep 25, 2020)

We are having the same issue with BCN and I've tried billing with the J3490 and it's denied as well....  anyone get any answers?


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## SharonCollachi (Sep 25, 2020)

It looks like Florida Blue has moved depo-provera to the pharmacy benefit for a lot of plans.  This usually means you cannot "buy and bill", but have to order it with a prescription for the patient.

Billing Guide (jump to the "Billing Drug Services on a  Professional Claim" section): https://www.floridablue.com/sites/f...ocs/Billing Guidelines Section 02 08 2019.pdf

Medication Guide for the different Florida Blue Plans, to see if depo-provera is now a pharmacy benefit:  https://www.floridablue.com/provide.../SA_Providers/SA_Pharmacy/SA_MedicationGuides


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## Sugarfoots2 (Oct 5, 2020)

I'm getting these denials from BCN and Molina in which they only deny J1050 with certain NDC's as they've paid when using different stock/NDC on a different dos....  I've also tried billing J3490 and that wasn't paid either.... I'm at a dead end with this... any help would be greatly appreciated.  Thank you


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## kcannon70 (Jun 30, 2021)

Sugarfoots2 said:


> I'm getting these denials from BCN and Molina in which they only deny J1050 with certain NDC's as they've paid when using different stock/NDC on a different dos....  I've also tried billing J3490 and that wasn't paid either.... I'm at a dead end with this... any help would be greatly appreciated.  Thank you


Did you ever figure this out. We are having the same problem!


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## SharonCollachi (Jun 30, 2021)

When an NDC code denies, I appeal with a copy of the box/container/vial showing the NDC code.


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## VeronicaAC1 (Nov 11, 2021)

Najwa said:


> Hello my coding peeps.
> Hello my coding peeps. Have any of you heard of BCBS denying claims for J1050 Depo Provera wanting you to bill J3490 Unlisteed drug because of NDC compatiability. This is what they are citing.
> 
> They are citing this source.
> ...


Is this the only source for this coding change?  Reason being is I still receive payments from Cigna, Aetna and United for the J1050 for Contraceptive Depo provera-  Not to mention, CMS does not cover Depo-Provera in general as a benefit, similar to them not covering Gardasil 9 so there is no allowable or acknowledgement when that is filed to CMS either- If anyone else can provide any other reputable source stating to use J3490 rather than J1050, please add to this thread- I do believe its NDC driven as there are pre-filled syringes for the Depo-Provera 150mg that have specific NDC codes


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## nielynco (Nov 15, 2021)

faraasha624 said:


> Billing with an unlisted code when there is a code that is specified as well as the specified code being listed in our contract would not be correct coding.


True, but the payer rule always trumps coding if you have it in writing.  Otherwise you will be providing a free service.


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