HealthCare News

Claims Submission Requirements forUnlisted Codes

Issue: #392 JAN2017

Topic: Coding/Billing


All unlisted CPT codes or unspecified HCPCS codes submitted on the CMS-1500 claim form that do not include a description of the service or procedure will no longer be accepted; they will be returned to the provider for correction. Non-specific codes may include in their description terms such as Not Otherwise Classified, Unlisted, Miscellaneous, Not otherwise specified, Unspecified or Unclassified.

Some examples of unlisted CPT codes include:

  • 21499 (Unlisted musculoskeletal procedure, head) – requires a description or claim will be returned to the provider.
  • 76499 (Unlisted diagnostic radiographic procedure) – requires a description or claim will be returned to the provider.

A non-specific HCPCS code is most often identified within the code definition. Some examples of unspecified or non-specific HCPCS include:

  • A9999 (Miscellaneous DME supply or accessory, not otherwise specified) – requires the product/supply description or the claim will be returned to the provider.
  • K0108 (Wheelchair component or accessory, not otherwise specified) – requires the product/supply description or the claim will be returned to the provider.
  • J7599 (Immunosuppressive drug, not otherwise classified) – requires the drug description, dosage and number of units or the claim will be returned to the provider.

The required information related to unlisted or nonspecific codes can be submitted in the following manner:

  • For electronic claim submission, the information is placed in the SV101-7 of the 2400 service line loop.
  • For paper claim submission, the information is placed in Box 19 of the CMS-1500 claim form.