Friday, July 8, 2016

Radiology or Other Diagnostic Unlisted Service or Procedure Billing Instructions


Some radiology and other diagnostic services may not have a corresponding HCPCS code. This is because these are typically services that are rarely provided, unusual, or new. The provider should assign the appropriate “unlisted procedure” code to any such service. The following list contains the “unlisted procedure” codes along with the suggested revenue code for billing. These services are paid on a fee schedule if one exists or cost if a fee has not been established for SNFs. However, before billing any of these codes the provider needs to furnish a complete description of the radiology procedure to the A/B MAC (A) for review and analysis. The description should include a narrative definition of the procedure and a description of the nature, extent and need for the procedure and the time, effort, and equipment necessary. The A/B MAC (A) will determine if the provider has correctly identified the procedure as “unlisted.” If the procedure is not identified correctly, the A/B MAC (A) will inform the provider of the correct HCPCS code to assign to the procedure. If there is no fee schedule amount established, these services are paid based on cost to SNFs.


For Radiology:


Revenue Code              HCPCS                             Definition

032x                             76499            Unlisted diagnostic radiologic procedure

0402                             76999            Unlisted ultrasound procedure

0333                             77299             Unlisted procedure, therapeutic radiology clinical treatment planning

0333                             77399             Unlisted procedure, medical radiation physics, dosimetry and treatment devices

0333                             77499            Unlisted procedure, therapeutic radiology clinical treatment management

0333                             77799            Unlisted procedure, clinical brachytherapy

034x                             78099            Unlisted endocrine procedure, diagnostic nuclear medicine

034x                             78199            Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear                                                          medicine

034x                              78299           Unlisted gastrointestinal procedure, diagnostic nuclear medicine

034x                              78399           Unlisted musculoskeletal procedure, diagnostic nuclear medicine

034x                              78499           Unlisted cardiovascular procedure, diagnostic nuclear medicine

034x                              78599           Unlisted respiratory procedure, diagnostic nuclear medicine

034x                              78699          Unlisted nervous system procedure, diagnostic nuclear medicine

034x                             78799            Unlisted genitourinary procedure, diagnostic nuclear medicine

034x                             78999            Unlisted miscellaneous procedure, diagnostic nuclear medicine

034x                             79999            Unlisted radiopharmaceutical therapeutic procedure


For Other Diagnostic Procedures:

075x                                91299            Unlisted diagnostic gastroenterology procedure

047x                                 92599           Unlisted otorhinolaryngological service or procedure

048x                                 93799           Unlisted cardiovascular service or procedure

073x                                 93799           Unlisted cardiovascular service or procedure

0921                                 93799           Unlisted cardiovascular service or procedure

046x                                 94799           Unlisted pulmonary service or procedure

074x                                 95999           Unlisted neurological or neuromuscular diagnostic procedure

0922                                 95999           Unlisted neurological or neuromuscular diagnostic procedure

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