Codapedia is now a division of Find-A-Code

No HCPCS Code Available? Now What?

February 21st, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Categories:   Billing   HCPCS Coding   Medicare  
0 Votes - Sign in to vote or comment.

HCPCS level II codes classify products into categories for the purpose of claims processing. HCPCS level II codes are alphanumeric with a descriptive terminology that identifies the item or service used primarily for billing purposes.

There are several types of HCPCS level II codes such as:

Most products and procedures have a code assigned; in fact, there are approximately 6,000 separate categories of items or services that include millions of products from different manufacturers.  However, when there is not a HCPCS code that accurately describes a particular service or product you are required to use a miscellaneous or not otherwise classified code.

In fact, there are many occasions you will find you need to use an unlisted HCPCS code, for example, if it is a new product or there has not been an application submitted to CMS to assign a new code. Using the unlisted, miscellaneous or unclassified drug code(s) require more information submitted on your claim form with additional attention and details when billing. 

New supplies or drugs are often left with an unspecified or unclassified code. Suppliers frequently contact us for a billing code on a new product when there is not a specific HCPCS code that fits the supply or drug they need to bill for, hoping to eliminate the need for the additional information to be reported on the claim form.   

For example for submitting a claim for an unlisted drug, you need to supply the payer with:

Name, strength, and dosage.   

Some Payers require different information, for example, United Healthcare requires the NDC number, quantity and the unit of measure when billing unlisted drugs. This required information on your claim should be submitted in block 19 on the CMS-1500 claim form (or in 2400.SV101-7 in the ANSI 837 claim file).

Before you give up your search for an appropriate HCPCS code and decide to use the unlisted or unclassified codes be sure to check out the DMEPOS Product search tool Find-A-Code offers.  This tool will allow you to search the product name, manufacturer name or model number giving you information that is not found with any other tool. This tool may help you avoid a claim denial due to an incorrect code, claims will be denied if there is a more specific code available and a non-specific code is billed. 

If there is not a specific HCPCS code contact the labeler or vendor to see if they have applied for a HCPCS code for their product, it may have already been requested and may be pending or if CMS HCPCS workgroup is considering a coding request. If you would like to request or suggest a revision or apply for a permanent HCPCS code you can contact CMS. 

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Finalized Confidentiality of Alcohol and Drug Abuse Patient Records Regulations
August 31st, 2018 - Wyn Staheli, Director of Research
In January, the U.S. Department of Health and Human Services (HHS) issued updates to the privacy regulations regarding the confidentiality of patient information of substance use disorder patients (42 CFR Part 2).  This notice included references to better alignment with HIPAA regulations, but did state that Part 2 is more protective ...
Pricing for ASC’s and APC’s
August 27th, 2018 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that...
PSAVE Pilot Program - What Does it Mean to You?
August 20th, 2018 - Wyn Staheli, Director of Research
Noridian's pilot program Provider Self-Audit with Validation and Extrapolation (PSAVE) has been extended which means that it has been successful for the payer, which means that they are saving money. Historically, when a pilot program is proven to be successful, it isn’t too long before other MACs follow. Before signing up to participate, providers need to carefully evaluate the program. Are the benefits worth the costs?
Importance of Depression Screenings
August 16th, 2018 - Wyn Staheli, Director of Research
Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ...
Using Modifiers 96 and 97
August 16th, 2018 - Wyn Staheli, Director of Research
The Affordable Care Act (ACA) requires coverage of certain essential health benefits (EHBs), two of which are rehabilitative and habilitative services and devices. Since the ACA did not define these terms or specify coverage requirements, it is left up to individual states to create benchmark plans to determine coverage requirements. ...
Medicare Timed Codes Guidelines
August 16th, 2018 - Wyn Staheli, Director of Research
Medicare's guidelines for reporting of timed codes is found in Medicare Claims Processing Manual Chapter 5, Section 20.2. Also known as the '8 minute' rule, it describes how to calculate time for appropriate reporting when more than one timed code is performed at the same time. It should be noted that while ...
QPro’s First Annual QPro Con
August 15th, 2018 - Chris Woolstenhulme QCC, CMCS, CPC, CMRS
Date: October 9-10 Time: 9-3 MST QPro Con is featuring a virtual event with keynote speakers and experts with years of hands-on experience in the healthcare industry. Stay ahead of the changes and keep informed of important information that affects the healthcare community. Attendees receive 12 FREE CEUs with the purchase ...



About Codapedia & Find-A-Code Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™/Find-A-Code™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2018 Find A Code, LLC - CPT® copyright American Medical Association