CurrentBlue Cross Blue Shield - New MexicoPolicy CPCPO35

Unlisted/Not Otherwise Classified (NOC) Coding Policy

Defines use, documentation, billing and reimbursement expectations for unlisted (NOC/NOS/NEC) CPT and HCPCS codes when no more specific code exists; applies to providers submitting claims to Blue Cross Blue Shield of New Mexico.

Policy Summary

PayerBlue Cross Blue Shield - New Mexico

PolicyUnlisted/Not Otherwise Classified (NOC) Coding Policy

Policy CodePolicy CPCPO35

Change TypeAnnual revieweditorial updates

Effective DateOct 17, 2025

Next Review DateN/A

Key ActionInclude a clear description and supporting documentation when submitting an unlisted CPT/HCPCS code; use a specific code when available.

SourceLink

POLICY UPDATE CHANGES

Annual Review; Grammatical and formatting updates; References updated

supporting documentation requiredwhen billing an unlisted code

one (1)unit value required for unlisted CPT/HCPCS codes

NDC 11-digitNDC billing number format required

Plan may request documentationPlan enforcement

Unlisted Code Reimbursement Criteria

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.

Unlisted code reimbursement criteria

Conditions under which unlisted codes will be considered for reimbursement:

Providers must select the accurate CPT/HCPCS code when available; use an unlisted code only if no more appropriate code exists.

Submission must include supporting documentation: an accurate and complete description of the drug, service, or procedure; all information supporting administration; invoices for unlisted DME or supplies when applicable; and NDC qualifier, NDC number, number of NDC units, and NDC unit of measure.

Documentation examples by service type

Anesthesia — special report describing nature, extent, need, time, effort, and equipment (e.g., CPT 01999).
Imaging/Radiology — diagnosis and imaging report including test(s) and results (e.g., CPT 76999).
Lab/Pathology — lab/pathology report; Item 19 of CMS-1500 must include specific test name(s) or short descriptor (e.g., CPT 86849).
Medical procedures — office notes and any relevant reports (e.g., CPT 96999, 95999).

Billing rules: unlisted CPT/HCPCS codes unit value must be reported as one (1); NOC drugs — do not quantity bill units unless directed; for institutional outpatient coding include drug name or NDC in UB-04 Box 43; CMS-1500 Item 19 must include the unlisted code description (attach if it does not fit); if an unlisted code appears in Item 24D, include a narrative description in Item 19.

Use the most specific unlisted code available; if a more appropriate specific code exists, claims submitted with an inappropriate unlisted code may be denied and should be corrected and resubmitted.

Code Examples, NDC and Unit Reporting

Example unlisted CPT/HCPCS codes and categoriesmixed

01999	Unlisted anesthesia procedure(s)
76999	Unlisted ultrasound procedure
86849	Unlisted immunology procedure
96999	Unlisted special dermatological service or procedure
95999	Unlisted neurological or neuromuscular diagnostic procedure
48999	Unlisted procedure; pancreas
A9999	Miscellaneous DME supply or accessory, not otherwise specified
E1399	Miscellaneous DME
J9999	Not otherwise classified, antineoplastic drugs
J3590	Unclassified biologicals

1–10 of 14

1/2

NDC units decimal precision — inv-03: key facts

NDC units decimal precisionPlan will accept up to three decimals in the NDC units (quantity) field.

NDC billing formatNDC must be submitted in 11-digit billing format (5-4-2) with leading zeros added as needed.

NDC submission requirementsSubmit NDC with accurate HCPCS/CPT code(s) and the number of HCPCS/CPT units; include unit of measure (e.g., UN, ML, GR).

Unlisted code unit reporting — inv-04: key facts

Unlisted code unit valueUnlisted CPT/HCPCS codes unit value must be reported as one (1).

Claim form item guidanceInclude the unlisted code description on CMS-1500 Item 19 (or electronic equivalent); if description does not fit, attach supporting documentation.

Procedure code narrativeIf an unlisted procedure code appears in Item 24D, include a narrative description in Item 19.

Provider Billing, Documentation and Authorization Requirements

Prior Authorization

Prior Authorization Check

Providers are urged to check the Plan's prior authorization list and other Plan documents to determine whether prior authorization is required before performing services. When applicable, obtain and document prior authorization according to the member's benefit plan and provider contract to avoid claim denials or delays.

Refer to the Plan's prior authorization list and applicable plan documents before scheduling services.
Prior authorization requirements are governed by the member's benefit plan and provider contract.

Documentation Required

Documentation & Billing Requirements

Providers must submit claims using valid HIPAA-approved code sets and follow industry-standard coding guidelines (for example, CPT, HCPCS, ICD-10-CM/PCS, UB conventions, CMS NCCI edits). When billing unlisted codes, include supporting documentation and a narrative description as required by claim form instructions.

Use the most specific unlisted code available when an appropriate specific code does not exist.
CMS-1500: include the unlisted code description in Item 19 (procedure code in Item 24D without description). If the description does not fit, attach supporting documentation.
UB-04 (institutional outpatient): when using an unlisted drug code, provide drug name and NDC in Box 43.
Unlisted CPT/HCPCS codes unit value must be reported as one (1).

Denial Risk

Documentation Request / Denial Risk

The Plan reserves the right to request supporting documentation for claims and to apply billing and coding policy rules during claims processing. Failure to provide requested documentation or to adhere to coding requirements (including inappropriate use of unlisted codes when a more appropriate code exists) may result in claim denial, reimbursement adjustment, or request for corrected claim submission.

If a more appropriate specific code exists, claims submitted with an unlisted code may be denied; submit a corrected claim with the appropriate code.
Upon request, submit supporting documentation to justify billed services, including descriptions for unlisted codes.
Claims are subject to code edit protocols, plan benefit terms, provider contract language, and clinical payment and coding policies.

Policy Metadata & Changes

Policy Number: CPCPO35

Effective Date: 2025-10-17

Last Reviewed: 2025-10-13

Next Review: Not specified

Status: CURRENT

Scope: Defines use, documentation, billing, and reimbursement expectations for unlisted (NOC/NOS/NEC) CPT and HCPCS codes when no more specific code exists; applies to providers submitting claims to Blue Cross Blue Shield of New Mexico.

Related Policies: Read with CPCPO34 — Unbundling Policy- Professional Provider.

Policy Update History: 09/22/2021 – New policy; 09/02/2022 – Annual Review; 08/15/2024 – Annual Review; 10/13/2025 – Annual Review; Grammatical and formatting updates; References updated.