Unlisted or Miscellaneous Codes
This reimbursement policy governs Anthem Medicare Advantage (Empire BlueCross region listings) reimbursement for claims billed with unlisted or miscellaneous CPT/HCPCS codes and what documentation is required for review; it affects providers submitting such claims for Anthem Medicare Advantage members.
Review approved and effective on 11/04/2024 with no changes.
Policy language clarified and unspecified removed in prior update.
Coverage Criteria
Documentation required for review
Reimbursement is contingent on individual claim review and sufficient documentation.
ALL of the following
- Provide an invoice with a written description of items and supplies.
- Provide a written description, office notes, or operative report describing the procedure or service performed.
- Provide the corresponding National Drug Code (NDC) for an unlisted code drug when applicable.
Required only when the unlisted code describes a drug.
ALL of the following
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