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Billing Unlisted CPT Codes to Insurance

What’s an Unlisted CPT code?

Most services that you perform at your practice are represented by specific codes in the CPT code set. However, sometimes you might perform a treatment that isn’t represented in the CPT code set. This is usually only the case for newer or more unique services.

This is where Unlisted CPT codes come in. An Unlisted CPT code is a like a “placeholder” code that doesn’t represent a specific service. Instead, its purpose is to accommodate unrepresented services so they can still be billed to insurance.

When you perform a service that doesn’t have an assigned CPT code, you can still bill the service to insurance by using the applicable Unlisted CPT code.

A number of codes have been added to the CPT library to accommodate unlisted services, but here are a few examples that might be relevant to your practice:

  • 97039 Unlisted modality (specify type and time if constant attendance)
  • 97139 Unlisted therapeutic procedure (specify)
  • 97799 Unlisted physical medicine/rehabilitation service or procedure
  • 99499 Unlisted evaluation and management service

How can I bill an Unlisted CPT Code through Jane?

Billing a claim with an Unlisted CPT code is just like billing a claim with specific procedure codes! The only difference is found in the process of setting up your clinic billing codes (US Insurance Step 2).

Just head to Settings > Billing Codes, search Jane’s CPT library for the Unlisted Code you need, and then click Assign Rate. Next, add in your clinic fee (Billed Amount) like usual.

Now here’s the difference.

Unlike specific procedures, you’ll need to add a custom Label to the billing code that describes the service in detail. You’ll also need to check the Include in claim submissions? box. This ensures the description of the service is sent in electronic and paper claim submissions (by default, billing code labels/descriptions are not included in claim submissions).

If you don’t check the Include in claim submissions? box, you most definitely will not be compensated by insurance, since the payer will have no context on what was performed (Unlisted Codes don’t have an inherent description).

Note that you do not need to include the Billing Code Label on claim submissions for listed/specific procedures. Only check the box for Unlisted Codes.

Where can I find the Unlisted Code Label on my claim submissions?

On the CMS1500 (paper claims), the billing code label is sent in Box 24 shaded (above the Unlisted Code).

  • Note that the two letter qualifier ZZ will be placed in front of the label on the CMS form. This tells the insurance company that the following text is a description of the service.

On electronic claims, the billing code label is included in Loop 2400 - Service Line Info, SV101-07

For example:

SV1*HC:97039:::::detailed description goes here...*100*UN*1***1~

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