Procedures For Which Codes Or Values Are Not Listed

(1) If a procedure is performed which is not listed in the rate tables, the health care provider shall use an appropriate CPT® procedure code or revenue code, as applicable. The provider shall submit an explanation, such as copies of operative reports, consultation reports, progress notes, office notes or other applicable documentation, or description of equipment or supply (when that is the bill). (2) The CPT® book contains procedure codes for unlisted procedures. These codes should only be used when there is no procedure code which accurately describes the service rendered. A special report is required. These services are reimbursed BR (By Report, see 0800-02-17- .03). (3) Where codes or other reports are listed with a dollar amount in these Rules, conversion to RVUs may be calculated by dividing the listed dollar amount by the Medicare Conversion Factor effective on the date of service. The Tennessee Specific Conversion Percentages are not applied to these codes or charges.