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Updated NDC/HCPCS Codes When Billing for Depo-Provera® (Medroxyprogesterone)

Audience: Participating Providers and Facilities

We would like to share an update on the coding required when billing for Depo-Provera (medroxyprogesterone) injections. Please submit all claims for these injections as indicated in the chart below with Healthcare Common Procedure Coding System (HCPCS) code J3490 and the appropriate National Drug Code (NDC) of the product being administered. 

This billing requirement applies to all lines of business.

Strength

HCPCS Code

NDC

Indication

150 mg / mL

J3490

Multiple

For the prevention of pregnancy

104 mg /0.65 mL

J3490

Multiple

For the prevention of pregnancy

Management of endometriosis-associated pain


Do not submit claims for Depo-Provera (medroxyprogesterone) injections with HCPCS code J1050 as it is associated with a single NDC (00009-0626-01) and strength (400 mg / mL) of Depo-Provera that is discontinued and is not indicated for pregnancy prevention. 

We understand this may require some changes in your billing system to update J1050 to J3490. As such, Univera Healthcare will postpone audits on medroxyprogesterone injections until October 1, 2022. We ask that you share this important information with your billing office/billing service and anyone within your practice who should be aware.

We also remind you that physician-administered drugs billed on an institutional claim form for patients with Managed Medicaid Care (MMC) and Health and Recovery Plan (HARP) coverage must have valid NDC and HCPCS codes. This is in accordance with guidance released in the February 2019 New York State Department of Health Medicaid update. 

Please note that CPT, ICD-CM, ICD-PCS and HCPCS codes are revised at various times of the year by the Centers for Medicare & Medicaid Services and/or the American Medical Association and the most accurate information should be included with claim submissions.   

Thank you for the quality of care and service that you provide to our valued members.

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