Use of Unlisted CPT or HCPCS Codes

To facilitate the prompt adjudication of claims, providers are reminded to submit documentation with any claim that contains an unlisted CPT or HCPCS code. Because an unlisted code can represent a wide variety of services, documentation should clearly indicate the procedure, service or supply that is being reported under the unlisted code. Documentation should also indicate why the procedure, service or supply was necessary. Claims reporting an unlisted code that are submitted without accompanying documentation will initially be denied and returned to providers with a Claims Adjustment Reason Code (CARC) of 16 (Claim/service lacks information or has submission/billing error(s) which is needed for adjudication) and a Remittance Advice Remark Code (RARC) of M127 (Missing patient medical record for this service) indicating that documentation is required before the claim can be processed.

Source: https://www.ucare.org/providers/Documents/2016March_UCareHealthLines_Final.pdf?utm_source=March%202016%20edition%20of%20UCare%20health%20lines&utm_campaign=March%202016%20edition%20of%20UCare%20health%20linested&utm_medium=email