HCPCS Level II J3490: Unclassified Drugs
HCPCS Level II code J3490 denotes billing for unclassified drugs that lack a specific HCPCS code, typically used for single-dose or specialty medications administered by clinicians; the service type is drug administration/medication supply, and the typical site of service is outpatient infusion centers, physician offices, or hospital outpatient departments where unlisted or newly marketed pharmaceuticals are provided and documented for clinical use.
For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only).
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National Reimbursement Benchmarks
Commercial national averages cluster modestly around the BUCA average commercial rate of $46.8, with Blue Cross Blue Shield showing a very low central tendency (median $0.1) but a moderate 75th–25th spread of $2.5, indicating most BCBS payments concentrate near zero with a small upper tail. UnitedHealth Group and Cigna sit above BUCA: UnitedHealth Group median $55.3 and interquartile spread $13.0 (P75 $65.0 minus P25 $52.0), while Cigna has a median $44.8 and interquartile spread $21.6 (P75 $54.4 minus P25 $32.0), suggesting Cigna payments are more dispersed than UnitedHealth Group.
Aetna exhibits the widest dispersion by far: its interquartile spread is $79.7 (P75 $79.7 minus P25 $7.0), reflecting substantial variability across contracts and some very high outliers (max $1715). BUCA’s central tendency provides a compact benchmark in the mid-$40s that sits between the tighter UnitedHealth Group distribution and the more variable Cigna and Aetna profiles.