J3490 HCPCS code: Unclassified drugs
J3490 is the HCPCS Level II code for unclassified drugs. In 2024 Medicare paid an average of $142.02 per service for J3490 across 605,090 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. Medicare volume fell 5% from 2022 to 2024 (634,700 to 605,090 services). In 2024, about 9,483 clinicians billed Medicare for J3490 for 76,071 beneficiaries; California, Washington, Florida accounted for 45% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 1986-01-01 |
| Last action effective | 1997-01-01 |
Who bills J3490 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 9,483 |
| Medicare beneficiaries | 76,071 |
| States with claims | 53 |
| Share of services in top 3 states (California, Washington, Florida) | 45% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J3490, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 634,700 | 74,260 | $156.39 | $124.43 |
| 2023 | 618,753 | 85,327 | $272.81 | $217.07 |
| 2024 | 605,090 | 76,071 | $179.18 | $142.02 |
States with the most J3490 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 104,391 | $99.52 |
| Washington | 83,210 | $20.79 |
| Florida | 82,631 | $216.48 |
| New York | 56,865 | $78.29 |
| Texas | 39,896 | $414.37 |
Medicare policy articles for this code
- A52451: Billing and Coding: Ranibizumab and biosimilars, Aflibercept, Aflibercept HD, Brolucizumab-dbll, Faricimab-svoa, PAVBLU™aflibercept-ayyh, AHZANTIVE®aflibercept-abzv. ENZEEVU™aflibercept-mrbb, OPUVIZ™aflibercept-yszy and YESAFILI™ aflibercept-jbvf (National Government Services, Inc. (MAC - Part A, MAC - Part B))
- A54880: Billing and Coding: Additional Claim Documentation Requirements for Not Otherwise Classified (NOC) Drugs and Biological Products with Specific FDA Label Indications (Palmetto GBA (MAC - Part A, MAC - Part B))
- A55913: Billing and Coding: Hospital Outpatient Drugs and Biologicals Under the Outpatient Prospective Payment System (OPPS) (Palmetto GBA (MAC - Part A))
- A56494: Billing and Coding: Cardiovascular Nuclear Medicine (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A57183: Billing and Coding: Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A57306: Billing and Coding: Transthoracic Echocardiography (TTE) (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A57615: Billing and Coding: Treatment of Males with Low Testosterone (Noridian Healthcare Solutions, LLC (MAC - Part A, MAC - Part B))
- A58828: Billing and Coding: Treatment of Males with Low Testosterone (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (1,661 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| I20.1 | Angina pectoris with documented spasm | 3 |
| I20.81 | Angina pectoris with coronary microvascular dysfunction | 3 |
| I20.89 | Other forms of angina pectoris | 3 |
| I21.01 | ST elevation (STEMI) myocardial infarction involving left main coronary artery | 3 |
| I21.02 | ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery | 3 |
| I21.09 | ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall | 3 |
| I21.11 | ST elevation (STEMI) myocardial infarction involving right coronary artery | 3 |
| I21.19 | ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall | 3 |
| I21.21 | ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery | 3 |
| I21.29 | ST elevation (STEMI) myocardial infarction involving other sites | 3 |
Showing 10 of 1,661. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J3490
- 1986-01-01: J3490 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J3490?
J3490 is the HCPCS Level II code for unclassified drugs. Short descriptor: "Drugs unclassified injection".
How much does Medicare pay for J3490?
In 2024, the average Medicare payment was $142.02 per service (average allowed $179.18).
Does Medicare cover J3490?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J3490?
Medicare policy articles that cite J3490 list 1,661 covered ICD-10-CM diagnosis codes across 8 articles. The most cited include I20.1 (Angina pectoris with documented spasm), I20.81 (Angina pectoris with coronary microvascular dysfunction), I20.89 (Other forms of angina pectoris). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
Related J34 codes
- J3400 — Injection, triflupromazine hcl, up to 20 mg
- J3401 — Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml
- J3402 — Injection, remestemcel-l-rknd, per therapeutic dose
- J3403 — Revakinagene taroretcel-lwey, per implant
- J3410 — Injection, hydroxyzine hcl, up to 25 mg
- J3411 — Injection, thiamine hcl, 100 mg
- J3415 — Injection, pyridoxine hcl, 100 mg
- J3420 — Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg
- J3424 — Injection, hydroxocobalamin, intravenous, 25 mg
- J3425 — Injection, hydroxocobalamin, intramuscular, 10 mcg
- J3430 — Injection, phytonadione (vitamin k), per 1 mg
- J3465 — Injection, voriconazole, 10 mg
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J3490
- Watch J3490 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J3490
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.