Q&A: Billing for services that don't have CPT codes

January 9, 2009

The AMA has implemented numerous changes to Category III codes, and some of them have transitioned to Level I CPT codes.

Q: We have been receiving rejections on claims for unlisted services that do not fit the description of any Current Procedural Terminology code, even though we submit a letter and the op report. We are confused because they keep asking us to submit the correct code. What do we need to do?

A: First, contact the insurer and find out specifically what is being requested. It may be the temporary Category III codes that exist for services that have not yet been assigned a CPT code. The American Medical Association has implemented numerous changes to Category III codes, and some of them have transitioned to Level I CPT codes. You may not submit an unlisted procedure if there is a Category III code that describes the service. If it is a Medicare claim, this may be the basis for your denials.