CurrentAnthemPolicy G-06004

Unlisted or Miscellaneous Codes (Reimbursement Policy)

Defines Anthem Medicare Advantage reimbursement approach for unlisted or miscellaneous CPT/HCPCS codes, requirements for claim documentation, and applicable states for Medicare Advantage products.

Policy Summary

PayerAnthem

PolicyUnlisted or Miscellaneous Codes (Reimbursement Policy)

Policy CodePolicy G-06004

Change TypeNo material changes in current revision

Effective Date11/04/2024

Next Review Date

Key ActionSubmit supporting documentation when billing unlisted or miscellaneous codes, including a written description or office/operative notes, an invoice with item descriptions, and the NDC for unlisted drug codes.

SourceLink

POLICY UPDATE CHANGES

Review approved and effective: updated policy template, clarified policy language, removed Unspecified from policy language, updated Definition section.

Review approved and effective: no changes.

11/04/2024effective / last approval date

Medicare Advantageproduct line covered

Documentation required (description, notes, invoice, NDC)minimum claim attachments for review

Coverage Criteria

Coverage criteria for unlisted/miscellaneous codes

Anthem Medicare Advantage allows reimbursement for unlisted or miscellaneous codes when documentation requirements are met; reimbursement is determined on an individual claim review basis.

Claims with unlisted or miscellaneous codes must include a written description or office/operative notes describing the procedure or service performed

Include an invoice with a written description of items and supplies for unlisted items

Provide the corresponding National Drug Code (NDC) for an unlisted drug code

Reimbursement is determined on an individual claim review basis

Claims may be rejected, denied, recouped, or adjusted if coding/billing guidelines are not followed

Policy Summary

PayerAnthem

PolicyUnlisted or Miscellaneous Codes (Reimbursement Policy)

Policy CodePolicy G-06004

Change TypeNo material changes in current revision

Effective Date11/04/2024

Next Review Date

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Coding

Unlisted / Miscellaneous codesmixed

unlisted CPT/HCPCS

Codes used when no existing specific CPT or Level II HCPCS code adequately describes the service, item, or procedure.

Review basis

Review basisReimbursement determined on individual claim review; claims with unlisted/miscellaneous codes are adjudicated per claim and require supporting documentation for consideration.

Required documentationInclude a written description, office notes, or operative report describing the procedure or service performed.

Invoice requirementProvide an invoice with a written description of items and supplies for unlisted items.

Unlisted drug codesSubmit the corresponding National Drug Code (NDC) when billing an unlisted drug code.

Use restrictionUse unlisted or miscellaneous codes only when no established code adequately describes the diagnosis, service, procedure, or item rendered.

Documentation & Claim Handling (Provider Actions)

Documentation Required

Attach required documentation when billing unlisted/miscellaneous codes

When billing with unlisted or miscellaneous CPT/HCPCS codes, submit supporting documentation with the claim: a written description (office notes or operative report) describing the procedure or service performed, an invoice with written descriptions of items and supplies, and the corresponding NDC for any unlisted drug code. Claims with unlisted or miscellaneous codes are reviewed on an individual claim basis and may be rejected, denied, recouped, or have reimbursement adjusted if coding/billing guidelines are not followed.

Include a written description, office notes, or operative report describing the procedure or service performed.
Attach an invoice with written description of items and supplies for unlisted items.
Provide the corresponding National Drug Code (NDC) for an unlisted drug code.
Be aware that reimbursement is determined by individual claim review; failure to follow coding/billing guidelines may result in claim rejection, denial, recoupment, or adjustment.

Definitions

Miscellaneous

Miscellaneous — definitionCodes submitted by a supplier for an item or service for which there is no existing code that adequately describes the item or service being billed.

Unlisted — definitionAn unlisted HCPCS code represents an item, service, or procedure for which there is no specific CPT or Level II alphanumeric HCPCS code; unlisted CPT codes often have descriptors starting with 'Unlisted' and commonly end in 99.

Policy referencesPolicy developed with consideration of CMS, the Federal Register, and applicable state contracts.

Unlisted

Unlisted — termAn unlisted HCPCS code represents an item, service, or procedure for which there is no specific CPT or Level II alphanumeric HCPCS code.

Descriptor guidanceThe CPT code book includes unlisted service/procedure codes at the end of sections; long descriptors start with 'Unlisted' and many codes end in 99.

When to useUse only when no existing specific CPT or Level II HCPCS code adequately describes the service, item, or procedure.