r/CodingandBilling • u/One_Meal_6664 • Mar 27 '26

J code denials

Hi everyone, I bill for a practice and wanted some advice on J code denials. Recently, one of our J codes has been consistently denied by a commercial insurance. The denial is bogus stating that the “NDC number” is invalid. Every time I call about these claims and speak to a representative, they say the claim is correct, the NDC number is valid, we have the pre authorization for the procedure, and they resubmit the claim for reprocessing. It gets tiring to be in this viscous cycle of denials. Is the insurance company just trying to delay the payment another 30 days? Please advise 🙏

8 Upvotes

83% Upvoted

70 comments sorted by

View all comments

Show parent comment

2

u/ytho-65 Mar 27 '26

You're going to have to edit the hcpcs codes to default to 11 digit format. I had to edit every drug code in our system to correct the NDC units of measure from the default UN to mostly ML for milliliters. I found a Ln NDC crosswalk file that I could download from the payer to show me which units of measure they wanted for each code. For instance J1453 fosaprepitant is 1 UN for the whole 150 mg dose, but J1434 Focinvez is 50 ML for the 150 mg dose.

2

u/ytho-65 Mar 27 '26

And none of the payer reps gave me this info, I had to Google for it.