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Office of Workers' Compensation Programs

Office of Workers' Compensation Programs (OWCP)

Automate J-Code Process

Effective June 17, 2012, prescription drugs dispensed from a physician's office, or submitted by non-pharmacy provider’s acting in a capacity as a billing agent for the purpose of dispensing pharmaceuticals, using procedure codes J3490, J8499, J8999, and J9999 will require an accompanying original National Drug Code (NDC), the Days Supply, and the physicians/organizations National Provider Identifier (NPI). All dispensed prescription drugs submitted correctly with the drug's original NDC will process through the Pharmacy Benefits Management System and will be priced based on the date of service in accordance with the published Average Wholesale Price (AWP) or the Medispan Average Wholesale (MAW) benchmark pharmacy rate. Services submitted for any of these codes without an accompanying NDC, Days Supply, line item charge and/or the NPI will be returned back to the sender.

For FECA/Black Lung Program: Any physician dispensed prescription drugs submitted using procedure code 99070 will require an accompanying original National Drug Code (NDC). Services submitted using procedure code 99070 without an accompanying description of the supplies or other materials provided (except spectacles) will be denied.

For Energy Program: Services submitted with procedure code 99070 will be denied. The Energy Program requires a level II HCPCS code.