When billing Medicare for any service, it is important that providers always use the most appropriate cpt code that accurately describes the procedure performed. after medical review, medicare will deny reported services with unclassified (noc) codes if true codes are available. this determination occurs regardless of any supporting documentation accompanying the claim.
Almost any well-established procedure in the medical field will have a true code. the purpose of a noc code is to report services that have absolutely no existing true code. Billers should use the reference aids available in the coding manuals before billing for any service with a NOC code. To find the actual code of a procedure, cross-reference the cpt index. the cpt has both indices and annexes to select a suitable code for billing purposes. Both procedures and body areas are included. look under the body area if the true code does not appear in the index under the procedure name.
Reading: What does noc mean in insurance
By design, the cpt procedure description helps to code procedures correctly. after selecting the correct code, you can find additional coding information for that particular body area or procedure in the main heading of that section. you should refer to the additional information available at the beginning of each cpt chapter for the correct application of the code. If you need additional help determining if a NOC code is correct, contact the American Medical Association (AMA).
Medicare may consider the deliberate use of inappropriate noc codes to maximize payments or “unbundling” procedures to be a fraudulent billing practice. Misrepresentation of non-covered or non-chargeable services with noc codes as approved covered services is also inappropriate.
To properly reimburse noc services, providers must include the following:
- in data 2400/sv101-7 or item 19 of the cms 1500 form, include a complete description of the service provided.
- This field contains up to 80 characters in the electronic claim.
- The claims reviewer will use this description to determine coverage and price service for comparable work.
- in data element 2400/sv1-04 or item 24g of form cms 1500, bill only one service unit.
- submit noc codes in data element 2400/sv101-2 in professional claim transaction 5010 (837p).
- provide a description in data element 2400/sv101-7.
- the 5010 tr3 implementation guide states: “use sv101-7 to describe non-specific procedure codes”. (Do not use the 2400 nte segment to describe procedure codes not specific to 5010.)
- the sv101-7 data element allows 80 bytes (ie characters, including spaces) of information.
- the name of the drug,
- the total dose (plus the strength of the dose, if applicable), and
- the administration method.
- varicose vein stab phlebectomy 1 extremity 6 stab incisions
- pharyngeal scar band lysed with monopolar cauterization
- arthroscopic decompression of the suprascapular nerve
- injection, factor VIII fusion fc (recombinant), per iu: 25,000 units
- unlisted breast surgery procedure
- not otherwise classified
- biological injection
Providers must include the following when reporting drugs and biologicals noc. this should appear in data element 2400/sv101-7, or element 19 of the cms 1500 form:
Important: Indicate a unit of service in data element 2400/sv1-04 or in element 24g of the CMS 1500 form. Even when providing multiple units, do not bill for quantity of medications and biological products. Medicare determines the appropriate payment for noc drugs and biologicals based on narrative information, not the number of units billed.
If medicare denies the noc drug and biological claim, the payment advice will include comment code m123. this comment means “missing/incomplete/invalid name, strength, or dose of drug supplied.” this occurs even if the rejection is due to the quantity of units invoiced.
Medicare determines the price of j noc codes based on the information provided in the average selling price (asp) noc pricing file. if the asp noc file lists the concentration of a drug in the file, this means that the drug comes in different strengths. Medicare payment varies depending on the force given. By billing Medicare for a NOC J-Code, you can determine if the drug comes in different strengths. To determine this, access the asp noc pricing files on the cms website.
Examples of good noc code descriptions:
examples of inadequate descriptions of noc codes:
an unprocessable rejection occurs when some of the above information is missing. will also occur when the claim shows more than one unit of service for the noc code.
special information for drugs noc and biological codes
the following tips will help you bill noc drugs and biologics, such as j3490, j3590, and j9999: