Billing

Unlisted and Not Otherwise Classified Procedure Codes

Table of Contents

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Unlisted and Not Otherwise Classified Procedure Codes

It is important, when billing any service, that providers always use the most appropriate CPT code that accurately describes the procedure performed.

The purpose of a NOC code is to report services having absolutely no existing code(s) that appropriately describe the service(s). Billers should use the reference aids available in the coding manuals before billing any service with a NOC code.

Upon medical review, services reported with NOC codes when specific codes are available will be denied; regardless of any supporting documentation accompanying the claim.

Medicare may view the deliberate use of inappropriate NOC codes for maximizing payments or "unbundling" procedures as a fraudulent billing practice. Misrepresentation of noncovered or non-chargeable services with NOC codes as approved, covered services is also inappropriate.

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Proper Billing for NOC Procedures

Electronic Claims

  • Loop 2400, SV101-7 - A detailed description of the service
  • Loop 2400, SV104 - Bill only one unit of service

Note: An unprocessable rejection occurs when any of the information above is missing/invalid.

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Paper Claims

  • Item 19 – A detailed description of the service
    • If submitting an attachment, please also indicate in Block 19 what is being attached (i.e. operative report attached, office notes, etc.)
  • Item 24G - Bill only one unit of service

Note: An unprocessable rejection occurs when any of the information above is missing/invalid.

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The following tips will help you bill NOC procedure codes

  • Do not file unlisted or NOC codes for procedures (i.e., surgical) when there is an appropriate CPT code
  • Do not file unlisted or NOC codes for procedures (i.e., surgical) without indicating a detailed description of the service being provided for payment
  • If you provide a comparable code for the service performed, include the actual name of the surgical or medical procedure

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Examples of adequate descriptions of NOC codes

  • Stab Phlebectomy of Varicose Veins 1 Extremity 6 Stab Incisions
  • Pharyngeal scar band lysed with monopolar cautery
  • Arthroscopic decompression of the suprascapular nerve

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Examples of inadequate descriptions of NOC codes

  • Breast Surgery Procedure Unlisted
  • Not Otherwise Classified
  • Biologic Injection

Reviewed 8/28/2024