Compound Drug Code

Claim filing for compounded drugs presents numerous challenges. Different payers may require different codes for the same drug creating confusion and claim filing errors. This confusion ends on July 1, 2015 when a new HCPCS Q-code becomes effective for all compounded drugs.

According to CMS Transmittal 3254, HCPCS code Q9977 “compounded drug, not otherwise classified (NOC)” becomes effective on July 1 2015. In the past, billers used J3490 or J3590; payers usually directed that claims for compounded drugs use these miscellaneous HCPCS codes. The most common compounded drug in ophthalmic practice is Avastin® (bevacizumab) which has been coded with a variety of nonspecific codes depending on the payer.

The introduction of this new HCPCS code should simplify and standardize claim filing for Avastin and all other compounded drugs. Several MACs have published this information on their individual websites. Commercial payers may or may not adopt this code.

The CMS transmittal can be found at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3254CP.pdf