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Unlisted CPT codes

March 01, 2012

The American Medical Association (AMA) owns copyright on the Current Procedural Terminology (CPT) that is used by all health care professionals to bill for their clinical care services. The AMA recognizes that there may be services that health care professionals provide that are not found in the CPT code set. Therefore, a number of specific code numbers have been designated for reporting unlisted procedures. There are many unlisted codes in the CPT book. Some examples of unlisted codes include:

99499 unlisted evaluation and management service
19499 unlisted procedure breast
29999 unlisted procedure arthroscopy
32999 unlisted procedure lungs and pleura
49659 unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy
59899 unlisted procedure, maternity care and delivery
64999 unlisted procedure, nervous system
86849 unlisted immunology procedure
89398 unlisted reproductive medicine laboratory procedure

Unlisted CPT codes are often used to represent new and emerging technologies for which U.S. Food and Drug Administration (FDA) approval has not yet been granted. Unlisted codes provide the means of reporting and tracking services and procedures until a more specific code is established.

Because unlisted and unspecified procedure codes are not specific, health care providers must submit supporting documentation so that billing can determine coverage and payment. Pertinent information should include:

  • A clear description of the procedure or service; its nature, and extent, and why it was needed
  • Whether the procedure was performed independent from other services provided, or if it was performed at the same surgical site or through the same surgical opening.
  • Any extenuating circumstances which may have complicated the service or procedure.
  • Time, effort, and equipment necessary to provide the service.
  • The number of times the service was provided.

When submitting supporting documentation, it is helpful to underline the portion of the report that identifies the test or procedure associated with the unlisted procedure code.

The bottom line is that it is inappropriate to select a CPT code for billing that is “closest to” describing the service provided. The CPT description must be an exact match for the services provided. If there is no exact match, an unlisted CPT code must be used.

Submitted by YSM Web Group on July 19, 2012