New Policies, Procedures for Unlisted Codes

TriWest Healthcare Alliance has implemented some new policies and procedures regarding the use of “Unlisted Codes” to ensure ongoing compliance with TRICARE policy.

Unlisted codes include Current Procedural Terminology (“CPT”) unlisted procedure codes as well as Healthcare Common Procedure Coding System (“HCPCS”) – Not Otherwise Classified (“NOC”), Not Otherwise Specified (“NOS”) and Miscellaneous Supply Codes.

Providers should only use unlisted codes when no other code will suffice. TriWest has priced many of the unlisted codes. Here is a summary of the changes, which are effective May 1, 2010:

• Claims with unlisted codes must contain a description of the service, a manufacturer’s number or an NDC, if appropriate.
• Claims with an unlisted code will be reviewed for an appropriate code. If an appropriate code is found, the line item will be denied and should be rebilled by the provider with an appropriate code.