Radiology or Other Diagnostic Unlisted Service or Procedure

120 - Radiology or Other Diagnostic Unlisted Service or Procedure Billing Instructions for A/B MAC (A) Claims (Rev. 1, 10-01-03) Some radiology and other diagnostic services may not have a corresponding HCPCS code. This is because these are typically services that are rarely provided, unusual, or new. The provider should assign the appropriate “unlisted procedure” code to any such service. The following list contains the “unlisted procedure” codes along with the suggested revenue code for billing. These services are paid on a fee schedule if one exists or cost if a fee has not been established for SNFs. However, before billing any of these codes the provider needs to furnish a complete description of the radiology procedure to the A/B MAC (A) for review and analysis. The description should include a narrative definition of the procedure and a description of the nature, extent and need for the procedure and the time, effort, and equipment necessary. The A/B MAC (A) will determine if the provider has correctly identified the procedure as “unlisted.” If the procedure is not identified correctly, the A/B MAC (A) will inform the provider of the correct HCPCS code to assign to the procedure. If there is no fee schedule amount established, these services are paid based on cost to SNFs. For Radiology: Revenue Code HCPCS Definition 032x 76499 Unlisted diagnostic radiologic procedure 0402 76999 Unlisted ultrasound procedure 0333 77299 Unlisted procedure, therapeutic radiology clinical treatment planning Revenue Code HCPCS Definition 0333 77399 Unlisted procedure, medical radiation physics, dosimetry and treatment devices 0333 77499 Unlisted procedure, therapeutic radiology clinical treatment management 0333 77799 Unlisted procedure, clinical brachytherapy 034x 78099 Unlisted endocrine procedure, diagnostic nuclear medicine 034x 78199 Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine 034x 78299 Unlisted gastrointestinal procedure, diagnostic nuclear medicine 034x 78399 Unlisted musculoskeletal procedure, diagnostic nuclear medicine 034x 78499 Unlisted cardiovascular procedure, diagnostic nuclear medicine 034x 78599 Unlisted respiratory procedure, diagnostic nuclear medicine 034x 78699 Unlisted nervous system procedure, diagnostic nuclear medicine 034x 78799 Unlisted genitourinary procedure, diagnostic nuclear medicine 034x 78999 Unlisted miscellaneous procedure, diagnostic nuclear medicine 034x 79999 Unlisted radiopharmaceutical therapeutic procedure For Other Diagnostic Procedures: Revenue Code HCPCS Definition 075x 91299 Unlisted diagnostic gastroenterology procedure 047x 92599 Unlisted otorhinolaryngological service or procedure 048x 93799 Unlisted cardiovascular service or procedure Revenue Code HCPCS Definition 073x 93799 Unlisted cardiovascular service or procedure 0921 93799 Unlisted cardiovascular service or procedure 046x 94799 Unlisted pulmonary service or procedure 074x 95999 Unlisted neurological or neuromuscular diagnostic procedure 0922 95999 Unlisted neurological or neuromuscular diagnostic procedure