CurrentPremera BluecrossPolicy N/A

Unlisted, Non-specific and Miscellaneous Procedure Codes

Defines Premera Blue Cross requirements for using and documenting unlisted/unspecified/miscellaneous CPT and HCPCS codes for all providers and facilities across specified Premera product lines (excludes Medicare Advantage).

Policy Summary

PayerPremera Bluecross

PolicyUnlisted, Non-specific and Miscellaneous Procedure Codes

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateApr 15, 2015

Next Review DateN/A

Key ActionSubmit detailed supporting documentation (operative reports, imaging, lab/path reports, office notes or narrative) with the claim to support reimbursement of unlisted codes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

supporting documentation requiredCondition for reimbursement of unlisted codes

not subject to prior authorizationUnlisted codes prior auth stance

pricing determined per claimPricing method

applies to all providers/facilitiesPolicy scope

annual reviews listedReview history

Coverage Criteria for Unlisted Codes

Coverage criteria for unlisted codes

Requirements and review process for unlisted/unspecified/miscellaneous CPT and HCPCS codes submitted on claims.

Supporting documentation must be submitted with the claim and must clearly describe the specific service(s) rendered (operative or procedure reports, imaging reports, laboratory/pathology reports, office notes, or a specific narrative).

Clearly identify the portion of the documentation that describes the test or procedure being billed with the unlisted code.

If a 'similar' or 'like' code exists, include the recommendation of the comparable code along with supporting documentation to assist review.

ALL of the following

RADIOLOGY/IMAGING: Provide description of the service on the claim line; diagnosis; reason for the procedure documented in provider notes; imaging reports with a full description of the unlisted service; any extenuating circumstances.

Policy Summary

PayerPremera Bluecross

PolicyUnlisted, Non-specific and Miscellaneous Procedure Codes

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateApr 15, 2015

Next Review DateN/A

Key ActionSubmit detailed supporting documentation (operative reports, imaging, lab/path reports, office notes or narrative) with the claim to support reimbursement of unlisted codes.

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.

Examples and Code Categories

Unclassified / Miscellaneous Drug HCPCSHCPCS

J3490	Unclassified biologics / drug, unclassified
J3590	Unclassified drug (specify)
J7599	Unclassified therapeutic drug, oral
J7699	Unclassified therapeutic drug, injectable
J7799	Unclassified drug, chemo (unlisted)
J7999	Unclassified drug or biologic
J8498	Unclassified antibiotic, other
J8499	Unclassified antimicrobial agent
J8999	Unclassified antiemetic/antiviral
J9999	Not otherwise classified, therapeutic drug

1–10 of 11

1/2

Unclassified / Miscellaneous DME HCPCSHCPCS

E1399	Durable medical equipment, miscellaneous
A9900	Services/supplies, miscellaneous
A9901	Miscellaneous medical supply
A9999	Miscellaneous pharmacy services
L8699	Prosthetic/orthotic supply, miscellaneous
L9900	Orthotic/prosthetic miscellaneous
T1999	DME miscellaneous, not otherwise classified
T5999	Miscellaneous DME supplies

Other Miscellaneous / Unclassified HCPCSHCPCS

H0046	Alcohol and/or drug services, unspecified
H0047	Addiction treatment, intensive
Q4051	Unlisted drug administration
Q4100	Unlisted supply
Q5009	Unlisted vaccine
S5181	Unlisted DME service
S8189	Unlisted supplemental service
S9445	Patient education, unlisted
S9446	Care planning, unlisted
S9810	Unlisted home health service

1–10 of 12

1/2

Unlisted Medical Procedure CPT RangesCPT

10021-69990	Surgical procedure CPT code range — unlisted codes require documentation/By Report
70010-79999	Radiology/imaging CPT code range — unlisted codes require documentation/By Report
80047-89398	Pathology/clinical lab CPT code range — unlisted codes require documentation/By Report
90281-99607	Medical procedure CPT code range — unlisted codes require documentation/By Report
By Report	Unlisted CPT codes billed 'By Report' require full documentation, recommendation of comparable code, and justification

Provider Billing and Documentation Requirements

Prior Authorization

No prior authorization — clinical review at claim

Unlisted, non-specific, and miscellaneous CPT and HCPCS codes are not subject to prior authorization; clinical review for coverage and medical necessity occurs at the time of claims submission/processing.

Documentation Required

Submit supporting documentation with claim

Submit supporting documentation with the claim that clearly describes the specific service(s) rendered (operative/procedure reports, imaging reports, laboratory/pathology reports, office notes, or a narrative). Failure to provide adequate supporting documentation will result in denial of reimbursement.

Clearly identify the portion of the report that corresponds to the unlisted procedure code.
If a similar or comparable code exists, include that recommendation with the documentation to assist review.

Billing Rule

Billing — reporting multiple unlisted codes

When multiple procedures are represented by the same unlisted/miscellaneous code, report that unlisted code only once with a single unit; if distinct anatomic locations require multiple unlisted codes, each may be reported with a single unit and supporting documentation must identify the locations.

Key Definitions

Unlisted/Non-specific/Miscellaneous Codes — definition

DefinitionUnlisted/Unspecified/Miscellaneous Codes are CPT or HCPCS codes whose descriptors include terms such as 'unlisted,' 'unspecified,' 'unclassified,' 'not otherwise specified (NOS/NOC),' 'not elsewhere classified (NEC),' or 'miscellaneous' and often end in XXX99 or XX999.

When to useUsed only when no more specific CPT or HCPCS code exists; these codes are a last resort and should not be used if a specific code is available.

PurposeProvide a mechanism to report and track services or procedures for which a specific code has not been established because the code description lacks detail about service components.

Typical location in codebooksOften found at the end of a code section or intermixed within a section and frequently end with numeric patterns like XXX99 or XX999.

Implication of improper useIf a more specific CPT or HCPCS code exists and an unlisted code is used instead, the claim may be denied or returned to the provider for correct coding.