Unlisted Procedure or Service

Billing and Reimbursement
Policy Number: RP-X-008

Last Updated: March 25, 2024 

When billing an unlisted code, providers must include a description of the service or item on the claim. The description should include:

  • Appropriate medical records (such as the operative report) for services. 
  • Documentation of the item provided (including the make, model and manufacturer) along with an invoice for equipment, supplies, orthotics/prosthetics.
  • The full NDC number must be submitted when billing for a drug/biologic. 

For professional claims, if the unlisted CPT/HCPCS code has not been assigned relative values by the Centers for Medicare & Medicaid Services, and no other fee schedule amount has been set by Blue Cross and Blue Shield of Nebraska, a comparable code may be used to determine the rate for the unlisted code.

Effective July 1, 2024, ASC Facilities will follow the same procedure as professional claims for Unlisted CPT/HCPCS codes.