CurrentBlue Cross Blue Shield - TexasPolicy CPCPO35

Unlisted / Not Otherwise Classified (NOC) Coding Policy

Defines when and how providers should bill unlisted (NOC/NEC/NOS) CPT/HCPCS codes, required supporting documentation, billing rules, and reimbursement considerations for Blue Cross and Blue Shield of Texas members.

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyUnlisted / Not Otherwise Classified (NOC) Coding Policy

Policy CodePolicy CPCPO35

Change TypeAnnual review — formatting and references updated

Effective DateOct 17, 2025

Next Review Date

Key ActionProviders must include specific supporting documentation with any claim billed with an unlisted code to avoid denial or audit.

SourceLink

POLICY UPDATE CHANGES

10/13/2025 annual review with grammatical and formatting updates and references updated.

CPCPO35policy number

Oct 17, 2025plan effective date

Supporting documentation requiredunlisted code submissions

1unlisted CPT/HCPCS units billed

When to Use an Unlisted (NOC/NEC/NOS) Code

When to use an unlisted code

Use an unlisted CPT/HCPCS code only when no specific code accurately describes the drug, supply, service, or procedure performed.

ALL of the following

No existing CPT or HCPCS code accurately describes the drug, supply, service or procedure.
Provider submits appropriate supporting documentation as required by the plan.

ALL of the following

No existing CPT or HCPCS code accurately describes the drug, supply, service or procedure.
Provider submits appropriate supporting documentation as required by the plan.

ALL of the following

No existing CPT or HCPCS code accurately describes the drug, supply, service or procedure.
Provider submits appropriate supporting documentation as required by the plan.

Documentation requirements for reimbursement

Unlisted code submissions must include supporting documentation appropriate to the code type.

ANY of the following

Accurate and complete description of the drug, service, or procedure.
Clinical records supporting administration, medical necessity, and separate provision of service if applicable (office notes, operative reports, imaging reports, lab/path reports).
Invoice for unlisted DME or supply codes (catalog/retail price listings are not acceptable).
NDC information for unclassified/unlisted drug codes including NDC qualifier, 11-digit NDC billing number (5-4-2 format), unit of measure, and NDC units (up to three decimals accepted).
For surgical unlisted procedures: explanation why standard CPT is not appropriate, comparable CPT/HCPCS codes and RVU/value comparison or percentage of comparable code, operative report and description of extent/need.

Thresholds

Unlisted CPT/HCPCS units billed1

Code Sets, NDC Billing, and Unlisted Code Examples

Example unlisted CPT/HCPCS codes and relatedCPT|HCPCS

01999	Unlisted anesthesia procedure(s) — example
76999	Unlisted ultrasound procedure — example
86849	Unlisted immunology procedure — example
96999	Unlisted special dermatological service or procedure — example
95999	Unlisted neurological or neuromuscular diagnostic procedure — example
48999	Unlisted procedure; pancreas — surgical example
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 billing guidanceNDC

NDC format

11-digit billing format (5-4-2) with leading zeros if needed; submit NDC qualifier, billing number, unit of measure and NDC units. One unit should be listed in 2400/SV1-04 or item 24G/24 in CMS-1500 or field 46 UB-04; do not quantity-bill CPT/HCPCS units for NOC drugs unless directed.

The policy reiterates that plan documents and provider contracts govern in the event of any conflict with this Clinical Payment and Coding Policy; Certificates of Benefits, benefit booklets, Summary Plan Descriptions, and similar coverage documents may take precedence. Providers should be aware that Blue Cross and Blue Shield of Texas (BCBSTX) has discretionary authority to interpret and apply this policy to individual cases, but plan and contract terms prevail where conflicts exist.

Providers must submit claims using HIPAA-approved code sets and follow industry-standard coding guidelines (for example, CPT, HCPCS, ICD-10, UB/CMS instructions and National Code/NDC billing guidance). Claims are subject to code edit protocols and may be reviewed against provider contracts, benefit terms, medical policies, clinical payment and coding policies, and coding software logic. Upon request, providers should be prepared to submit additional documentation to support billed services.

What Providers Must Do

Documentation Required

Submit supporting documentation with unlisted codes

Providers must include specific supporting documentation with any claim billed with an unlisted code. Required materials vary by service type and may include operative reports, imaging/lab reports, office notes, invoices for DME, NDC details for drugs, and special reports for anesthesia or E/M. Lack of documentation may lead to denial or audit.

Billing Rule

Use most specific unlisted code and correct claim form fields

Select the most specific unlisted code available. On CMS-1500, include description in Item 19 (attach if space insufficient) and procedure code in Item 24D; for UB-04 institutional outpatient claims using an unlisted drug code, include medication name or NDC in Box 43. Unlisted CPT/HCPCS codes unit value must be reported as one (1).

Denial Risk

Claims may be denied if a more appropriate code exists or documentation is missing

If a claim includes an unlisted code but a more appropriate specific code exists, the claim may be denied and a corrected claim will be required. The Plan may request additional documentation and reserves the right to review and audit unlisted code payments.

Prior Authorization

Check prior authorization requirements

Providers are urged to consult the Plan's prior authorization list and other plan documents to determine if prior authorization is required for the service associated with an unlisted code.

Policy Purpose and Scope

This policy defines when and how providers should bill unlisted/Not Otherwise Classified (NOC/NEC/NOS) CPT or HCPCS codes: use an unlisted code only if no specific CPT or HCPCS code accurately describes the drug, supply, service, or procedure performed. Unlisted codes are intended as a last resort when a more appropriate specific code does not exist.

When submitting an unlisted code, providers must include supporting documentation appropriate to the code type. Required materials may include an accurate description of the service or drug, office or operative notes, imaging or lab reports, an invoice for unlisted DME, NDC details for drugs (including NDC qualifier, 11-digit 5-4-2 billing number, unit of measure, and NDC units), or a special report for anesthesia or unlisted E/M services describing nature, extent, time/effort and complexity.

Billing rules specify that unlisted CPT/HCPCS units must be reported as one (1). On a CMS-1500 claim, include the unlisted code in Item 24D and a narrative description in Item 19 (or attach supporting documentation if Item 19 does not fit). For institutional outpatient UB-04 claims using an unlisted drug code, include medication name or NDC in Box 43. If an appropriate specific code exists, the claim may be denied and a corrected claim will be required; the Plan reserves the right to request additional documentation and to audit unlisted code payments.

Key Terms

Definitions

Unlisted codeA CPT or HCPCS code used when no specific code accurately describes the drug, supply, service, or procedure performed. Identified by terms such as Unlisted, Not Otherwise Classified (NOC), Not Elsewhere Classified (NEC), Not Otherwise Specified (NOS), Unspecified, or Non-Specified.

NDC billing number11-digit National Drug Code in 5-4-2 configuration required for unclassified drug billing; leading zeros must be added as needed.

Special reportSupplemental documentation providing a detailed description of the service, time/effort, equipment, clinical rationale, and other details required when billing certain unlisted codes (e.g., anesthesia, E/M, surgical unlisted codes).

Policy Updates

2025-10-13Annual review / formatting & references updatedLatest

Annual review with grammatical and formatting updates and references updated; no specific substantive coverage or coding rule changes were identified.

2024-08-15Annual review

Annual review.

2022-09-02Annual review

Annual review.

2021-09-22Policy creation

New policy established (initial publication).

Policy Summary

PayerBlue Cross Blue Shield - Texas

PolicyUnlisted / Not Otherwise Classified (NOC) Coding Policy

Policy CodePolicy CPCPO35

Change TypeAnnual review — formatting and references updated

Effective DateOct 17, 2025

Next Review Date

Key ActionProviders must include specific supporting documentation with any claim billed with an unlisted code to avoid denial or audit.

SourceLink

On This Page

ANY of the following

Accurate and complete description of the drug, service, or procedure.
Clinical records supporting administration, medical necessity, and separate provision of service if applicable (office notes, operative reports, imaging reports, lab/path reports).
Invoice for unlisted DME or supply codes (catalog/retail price listings are not acceptable).
NDC information for unclassified/unlisted drug codes including NDC qualifier, 11-digit NDC billing number (5-4-2 format), unit of measure, and NDC units (up to three decimals accepted).
For surgical unlisted procedures: explanation why standard CPT is not appropriate, comparable CPT/HCPCS codes and RVU/value comparison or percentage of comparable code, operative report and description of extent/need.
For anesthesia unlisted services: special report including nature, extent, time, effort and equipment necessary.
For unlisted E/M services: special report with nature/extent, time/effort, complexity, diagnosis, findings and follow-up.

Unlisted / Not Otherwise Classified (NOC) Coding Policy

When to Use an Unlisted (NOC/NEC/NOS) Code

Code Sets, NDC Billing, and Unlisted Code Examples

What Providers Must Do

Policy Purpose and Scope

Key Terms

Also See

Policy Updates