Unlisted Procedure and Not Otherwise Classified Codes
When billing a service or procedure, select the CPT or HCPCS code that accurately identifies the service or procedure performed. If no such code exists, report the service or procedure using the appropriate "unlisted procedure code or Not Otherwise Classified (NOC) code" (which often end in 99). Noridian will not correctly code unlisted codes when a valid code is available.
It is the responsibility of the provider to ensure all information required to process unlisted procedure codes or NOC codes is included on the CMS-1500 form or the electronic media claim (EMC) when the claim is submitted. If required information is missing, the code will be deemed unprocessable.
An unlisted procedure code or NOC must have a concise description of the services rendered in Item 19 on the CMS-1500 claim form or electronic equivalent. The electronic equivalent for Item 19 on EMC submissions will hold up to 80 characters for the concise statement and should be enough space to describe the unlisted procedure code. If the description does not fit in Item 19, providers who submit paper claims should include an attachment to describe the services. PWK segment is provided. See PWK article titled "Submitting Paperwork (PWK) Electronically."
Do not submit a written request or contact the Noridian Provider Call Center to inquire if the description is appropriate for payment. We cannot determine if the comment is sufficient for payment without viewing the entire claim.
Unclassified Drug Billing
The following unclassified drug codes should be used only when a more specific code is unavailable:
- J3490 - Unclassified drugs
- J3590 - Unclassified biologics
- J9999 - Not otherwise classified, anti-neoplastic drug
When submitting a claim using one of the codes listed above, enter the drug name and dosage in Item 19 on the CMS 1500-claim form or the electronic equivalent. Pricing will be based on the information entered in these fields. The quantity-billed field must be entered as one (1). If required information is missing, the code will be deemed unprocessable.
Compound Drug Billing Exception
An exception to the unclassified drug code instruction above is the billing of compound drugs (often prepared by special pharmacies), which should be billed as outlined in the companion articles published simultaneously with this article:
- Compounded Drugs Reimbursement Billing
- Infusion Drugs Reimbursement Billing
If there is a valid J-code for the drug billed, the unlisted code will not be correctly coded by Noridian. The unlisted code will be denied as a billing error. Medicare payment will be based on the information submitted. If the required information is not submitted, any unlisted procedure or service will be denied as unprocessable.
- CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 26, Section 10.4
Last Updated Oct 18, 2018