Not Otherwise Classified Codes

Correct Healthcare Common Procedure Coding System (HCPCS) coding is imperative when providing DMEPOS items to a beneficiary. Suppliers are required to correctly code for the item billed. An item/service is correctly coded when it meets all the coding guidelines listed in CMS HCPCS guidelines, LCDs, LCD-related Policy Articles, or DME MAC articles. Medicare will deny services reported with not otherwise classified (NOC) codes if valid codes are available for item. Noridian will not correctly code a billed NOC code when a valid HCPCS code is available.

Items billed with any HCPCS code with a narrative description that indicates miscellaneous, NOC, unlisted, or non-specified, must also include the following information in loop 2400 (line note), segment NTE02 (NTE01=ADD) of the ANSI X12N, version 5010A1 professional electronic claim format or on Item 19 of the paper claim form in the narrative field.

Narrative added to claim:

  • Description of the item or service
  • Manufacturer name
  • Product name, model name and number
  • Supplier Price List (PL) amount (this is the same amount billed on the claim line)
  • HCPCS code of related item (if applicable)
  • If Repair part, HCPCS code of item being repaired

If claim is denied, request redetermination with all documentation to support medical necessity

  • Medical necessity for item (medical records)
  • If item is custom-fabricated, provide complete and clear description of item including:
    • What makes item unique
    • Breakdown of charges (materials and labor)

The NTE 2400 Field of an electronic claim is limited to 80 characters; therefore, suppliers are encouraged to use our list of Common Abbreviations to Use as Narratives to condense all of the required information into this field.

Miscellaneous HCPCS codes billed without this information will be rejected and will need to be resubmitted with the missing information included.

Gap Filling

The fee schedule for items for which charge data is not available or published is calculated based on:

  • Fee schedule amounts for comparable equipment
  • Fee schedule amounts of other DME MACs
  • Supplier price lists
  • Manufacturers wholesale price

Where supplier price lists are used, efforts are made to obtain prices in effect during the base year. Mail order catalogs are often used as sources of price information. A deflation factor is applied if the price information is from a period other than the base period. This is done to approximate the base year price for gap filling purposes. For more information on the pricing methodology used for unpublished fee schedules review Internet-Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 23, Fee Schedule Administration and Coding Requirements.

Individual Local Coverage Determination (LCD) or Policy Articles (PA) will have specific NOC coding information. Visit Noridian’s website for specific LCDs or PAs for policy specific NOC codes. For questions about correct coding, contact the Pricing, Data Analysis, and Coding (PDAC) contractor.

Last Updated Dec 20 , 2023