CurrentBlue Cross Blue Shield - OklahomaPolicy CPCP035

Unlisted/Not Otherwise Classified (NOC) Coding Policy

Describes when and how providers should bill using unlisted (NOC/NOS/NEC) CPT or HCPCS codes, required supporting documentation, and billing/reimbursement expectations for Blue Cross Blue Shield of Oklahoma members and providers.

Policy Summary

PayerBlue Cross Blue Shield - Oklahoma

PolicyUnlisted/Not Otherwise Classified (NOC) Coding Policy

Policy CodePolicy CPCP035

Change TypeNo material change

Effective DateOct 17, 2025

Next Review DateOct 13, 2025

Key ActionSubmit supporting documentation when billing unlisted CPT/HCPCS codes and report as one (1) unit.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

supporting documentation requiredwhen unlisted codes are billed

unit = 1unlisted code reporting

Plan may request docsreimbursement conditionality

specialty guidanceexamples provided

Unlisted Code Coverage Criteria

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Use a specific CPT/HCPCS code when available; use an unlisted code only if no appropriate code exists.

Submit supporting documentation with unlisted code claims, including a complete and accurate description of the drug, service, or procedure and all related administration details.

Include invoices for unlisted DME or supply codes and provide NDC qualifier, NDC number, number of NDC units, and NDC unit of measure when applicable.

Indicate whether the drug, service, or procedure was provided separately from any other service or procedure and include any additional information necessary to evaluate the claim.

Report unlisted CPT/HCPCS codes as one (1) unit on claims; follow CMS-1500 and UB-04 guidance for where to place unlisted code description and drug/NDC information.

See billing instructions for Item 19 (CMS-1500) and Box 43 (UB-04).

If an unlisted code is submitted but a more appropriate specific code exists, the claim may be denied and a corrected claim with the appropriate code should be submitted.

The Plan reserves the right to request additional supporting documentation and will determine payment; failure to adhere to billing and coding policies may impact claims processing and reimbursement.

CPT / HCPCS Unlisted Code Guidance

Example unlisted CPT/HCPCS codes and groupsmixed

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

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Unlisted code units reported

Unit reportingReport unlisted CPT/HCPCS codes as one (1) unit on claims.

Do not quantity bill NOC drugsDo not quantity bill Not Otherwise Classified (NOC) drugs unless specifically directed by the Plan.

CMS-1500 requirementsInclude the description of the unlisted code in Item 19 (or attachment if it does not fit); include procedure code in Item 24D; if an unlisted procedure code is in 24D, include a narrative in Item 19.

UB-04 institutional outpatientWhen using an unlisted drug code, provide the drug name/NDC in Box 43 of the UB-04 form.

Provider Billing and Documentation Actions

Prior Authorization

Check prior authorization requirements

Providers are urged to consult the Plan's prior authorization list and other Plan documents to determine if a prior authorization is required before billing an unlisted code.

Denial Risk

Plan may request supporting documentation — risk of denial

The Plan reserves the right to request supporting documentation; failure to follow billing and coding policies may affect claims processing and reimbursement and may result in denial if a more appropriate code exists.

If a claim uses an unlisted code but a more appropriate code exists, the claim may be denied and a corrected claim should be submitted.

Terminology: Unlisted Code Variants

Unlisted code terminology

NEC/Not Otherwise Classified (NOC)Terms that identify an unlisted code include 'Not Elsewhere Specified (NEC)' and 'Not Otherwise Classified (NOC)'.

NOS/Not Otherwise Specified'Not Otherwise Specified (NOS)' is used to indicate an unlisted or unspecified code when no more specific code exists.

Non-Specified / Unspecified / Unlisted / UnclassifiedOther terms the policy lists for unlisted codes: 'Non-Specified', 'Not Listed', 'Unlisted', 'Unspecified', and 'Unclassified'.