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Unlisted CPT, Unclassified HCPCS and NDC Codes


Provider Administrative Policy

Section
Claims Submission
Policy Date
February 2008
Status/Date
Revised/March 2013
Provider Type(s)
All Providers  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Unlisted CPT, Unclassified HCPCS and NDC Codes

Please include an explanation of the service performed when submitting claims for an unlisted CPT code or an unclassified HCPCS code. Submit all unlisted and unclassified codes with a quantity of '1'. All unlisted and unclassified codes are subject to review.

Please submit unlisted CPT codes (i.e. 33999) with an explanation of the specific procedure performed. Submit unclassified drug codes (i.e. J8499) with the NDC and narrative description of the corresponding pharmaceutical submitted.

If you submit a paper claim, please note the descriptive information in field 19 of the CMS-1500 form, or field 80 of the UB-04 form. If you file a claim electronically, please use the ‘remarks’ field for the description and NDC.

We will return any claim containing an unclassified drug code without a description and NDC for additional information.


Policy History

Date Action Reason
March 2013 Revised Added clarification on billing units of '1'
March 2012 Revised Removed reference to HCPCS J3490, added language regarding field 80
March 2009 Revised "Subject to review" line moved to first paragraph

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