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HCPCS J3490 · Level II · J code

J3490: Unclassified drugs, HCPCS Level II J code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for J3490

Medicare payment
no PFS amount
PFS status E
Coverage code
D
special coverage instructions apply
MUE
none published
no MUE in the 2026 Q4 tables
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
6 / 8

TL;DR

CMS describes HCPCS J3490, added in 1986, as "Unclassified drugs". The physician fee schedule lists J3490 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. 6 active LCDs and 8 billing and coding articles list J3490 across 20 states: L33394 (Drugs and Biologicals, Coverage of, for Label and Off-Label Uses), L34324 (Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography), A52451, A54880. OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS O1E (other drugs); pricing indicator 51; type of service 1 (medical care), P (lump-sum purchase of DME, prosthetics or orthotics). Nearby codes: J3590, J2787, J2004, J2003.

J3490 descriptor and code status

The October 2026 HCPCS Level II file describes J3490 as “Unclassified drugs”. It sits in the J section (drugs administered other than oral method and chemotherapy drugs), listed with the other J codes without an ASP payment limit. Although searches often call it the "J3490 CPT code", J3490 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of J3490
FieldValue
Short descriptorDrugs unclassified injection
Added to HCPCS1986-01-01
Last actionN (no maintenance), effective 1997-01-01
Coverage codeD: special coverage instructions apply
Pricing indicator51: drugs
BETOS categoryO1E: other drugs
Type of service1: medical care; P: lump-sum purchase of DME, prosthetics or orthotics

Medicare payment for J3490

The physician fee schedule lists J3490 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status E: excluded from the physician fee schedule by regulation. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Ambulatory surgical center (Addendum BB)

Payment indicator N1 (Packaged service/item; no separate payment made).

Medically Unlikely Edits for J3490

CMS publishes no MUE for J3490 in the 2026 Q4 practitioner, facility or DME supplier tables. Some MUE values are confidential and applied without publication, so unit limits can still deny; document the quantity furnished on every claim.

The MUE lookup for J3490 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists J3490 in v323r0.

J3490 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check J3490 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for J3490

6 active Local Coverage Determinations and 8 billing and coding articles list J3490. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Billing and Coding Articles listing J3490
ArticleTitleContractor(s)Related LCD
A52451Billing and Coding: Ranibizumab, Aflibercept and biosimilarsWellpoint FederalL33394
A54880Billing and Coding: Additional Claim Documentation Requirements for Not Otherwise Classified (NOC) Drugs and Biological Products with Specific FDA Label IndicationsPalmetto GBA—
A55913Billing and Coding: Hospital Outpatient Drugs and Biologicals Under the Outpatient Prospective Payment System (OPPS)Palmetto GBA—
A56494Billing and Coding: Cardiovascular Nuclear MedicineCGS Administrators, LLCL33960
A57183Billing and Coding: Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress EchocardiographyNoridian Healthcare Solutions, LLCL34324, L36887
A57306Billing and Coding: Transthoracic Echocardiography (TTE)CGS Administrators, LLCL34338
A57615Billing and Coding: Treatment of Males with Low TestosteroneNoridian Healthcare Solutions, LLCL36538
A58828Billing and Coding: Treatment of Males with Low TestosteronePalmetto GBAL39086

Denials to expect on J3490

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists J3490

CARC 151 · N362

units exceed what the payer considers medically likely for one date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for J3490 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for J3490 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS J3490

What does HCPCS code J3490 describe?

"Unclassified drugs" (short descriptor "Drugs unclassified injection"), in the J section (drugs administered other than oral method and chemotherapy drugs). Added 1986-01-01; last action N (no maintenance) effective 1997-01-01.

Is J3490 a CPT code?

It is not. J3490 belongs to the J section (drugs administered other than oral method and chemotherapy drugs) of HCPCS Level II, the CMS code set, not to AMA CPT. "J3490 CPT code" searches refer to it.

What does Medicare pay for J3490?

The physician fee schedule lists J3490 with status E (excluded from the physician fee schedule by regulation), so the PFS carries no national amount for it.

Does Medicare cover J3490?

Coverage code D (special coverage instructions apply). 6 active LCDs and 8 billing and coding articles list J3490 across 20 states: L33394 (Drugs and Biologicals, Coverage of, for Label and Off-Label Uses), L34324 (Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography), A52451, A54880.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.