Because unlisted and miscellaneous codes do not provide clear information about the service or item being billed, HMSA requires that additional information accompany claims for any service or item being billed.
The type of information required will vary depending on the type of service or item being billed. For example:
- If the service is a diagnostic test, clinical notes should be included describing the patient's diagnoses, the test performed and the results of the test.
- If the item is a DME item, the name of the item, a description, the manufacturer, product number and a copy of the invoice should be included.
- If the miscellaneous service is a drug (e.g., J3490), the NDC number of the drug and dosage information should be listed on the claim.
For unlisted surgery codes, please be sure to attach the following supporting documentation:
- A clear definition or description of the nature, extent and need for the procedure. Indicate why it cannot be addressed with the standard coded CPT procedures.
- An operative report.
- Provide a reasonably comparable service code/procedure, value in comparable RVU and/or percentage of a reasonably comparable CPT.
For unlisted molecular pathology codes, please be sure to attach the following supporting documentation:
- A clear definition or description of the nature, extent and need for the procedure. Indicate why it cannot be addressed with the standard coded CPT procedures.
- If no clear definition/description referenced, medical notes from referring physician, lab orders and results for review are needed to avoid delays in claims processing.
- The submitting/rendering laboratory’s invoice.
For other types of services or items, providers should consider what type of information would best help HMSA understand what exactly is being billed. If HMSA has any further questions about the service or item, additional information may be requested.
The tables below include the unlisted or miscellaneous services and items for which additional information is required.
I. CPT Codes for Unlisted Services
A. Anesthesia Codes
| Code | Description |
|---|---|
| 01999 | Unlisted anesthesia procedure(s) |
B. Surgery Codes
| Code | Description |
|---|---|
| 15999 | Unlisted procedure, excision pressure ulcer |
| 17999 | skin, mucous membrane and subcutaneous tissue Refer to the policy: Gender Identity Services [PDF] |
| 19499 | breast |
| 20999 | musculoskeletal system, general |
| 21089 | Unlisted maxillofacial prosthetic procedure |
| 21299 | Unlisted craniofacial and maxillofacial procedure |
| 21499 | Unlisted musculoskeletal procedure, head |
| 21899 | Unlisted procedure, neck or thorax |
| 22899 | spine |
| 22999 | abdomen, musculoskeletal system |
| 23929 | shoulder |
| 24999 | humerus or elbow |
| 25999 | forearm or wrist |
| 26989 | hands or fingers |
| 27299 | pelvis or hip joint |
| 27599 | femur or knee |
| 27899 | leg or ankle |
| 28899 | foot or toes |
| 29799 | casting or strapping |
| 29999 | arthroscopy |
| 30999 | nose |
| 31299 | accessory sinuses |
| 31599 | larynx |
| 31899 | trachea, bronchi |
| 32999 | lungs and pleura |
| 33999 | cardiac surgery |
| 36299 | vascular injection |
| 37501 | Unlisted vascular endoscopy procedure |
| 37799 | Unlisted procedure, vascular surgery |
| 38129 | Unlisted laparoscopy procedure, spleen |
| 38589 | lymphatic system |
| 38999 | Unlisted procedure, hemic or lymphatic system |
| 39499 | mediastinum |
| 39599 | diaphragm |
| 40799 | lips |
| 40899 | vestibule of mouth |
| 41599 | tongue, floor of mouth |
| 41899 | dentoalveolar structures |
| 42299 | palate, uvula |
| 42699 | salivary glands or ducts |
| 42999 | pharynx, adenoids, or tonsils |
| 43289 | Unlisted laparoscopy procedure, esophagus |
| 43499 | Unlisted procedure, esophagus |
| 43659 | Unlisted laparoscopy procedure, stomach |
| 43999 | Unlisted procedure, stomach |
| 44238 | Unlisted laparoscopy procedure, intestine (except rectum) |
| 44799 | Unlisted procedure, intestine |
| 44899 | Meckel's diverticulum and the mesentery |
| 44979 | Unlisted laparoscopy procedure, appendix |
| 45499 | rectum |
| 45999 | Unlisted procedure, rectum |
| 46999 | anus |
| 47379 | Unlisted laparoscopy procedure, liver |
| 47399 | Unlisted procedure, liver |
| 47579 | Unlisted laparoscopy procedure, biliary tract |
| 47999 | Unlisted procedure, biliary tract |
| 48999 | pancreas |
| 49329 | Unlisted laparoscopy procedure, abdomen, peritoneum and omentum |
| 49659 | hernioplasty, herniorrhaphy, herniotomy |
| 49999 | Unlisted procedure, abdomen, peritoneum and omentum |
| 50549 | Unlisted laparoscopy procedure, renal |
| 50949 | ureter |
| 51999 | bladder |
| 53899 | urinary system |
| 54699 | testis |
| 55559 | spermatic cord |
| 55899 | Unlisted procedure, male genital system |
| 58578 | Unlisted laparoscopy procedure, uterus |
| 58579 | Unlisted hysteroscopy procedure, uterus |
| 58679 | Unlisted laparoscopy procedure, oviduct, ovary |
| 58999 | Unlisted procedure, female genital system (nonobstetrical) |
| 59897 | Unlisted fetal invasive procedure, including ultrasound guidance |
| 59898 | Unlisted laparoscopy procedure, maternity care and delivery |
| 59899 | Unlisted procedure, maternity care and delivery |
| 60659 | Unlisted laparoscopy procedure, endocrine system |
| 60699 | Unlisted procedure, endocrine system |
| 64910 | Nerve repair; with synthetic conduit or vein allograft (e.g., nerve tube), each nerve |
| 64911 | With autogenous vein graft (includes harvest of vein graft), each nerve |
| 64912 | Nerve repair; with nerve allograft, each nerve, first strand (cable) |
| 64913 | Nerve repair; with nerve allograft, each additional strand (list separately in addition to code for primary procedure) |
| 64999 | nervous system |
| 66999 | anterior segment of eye |
| 67299 | posterior segment |
| 67399 | ocular muscle |
| 67599 | orbit |
| 67999 | eyelids |
| 68399 | conjunctiva |
| 68899 | lacrimal system |
| 69399 | external ear |
| 69799 | middle ear |
| 69949 | inner ear |
| 69979 | temporal bone, middle fossa approach |
C. Radiology Codes
| Code | Description |
|---|---|
| 76496 | Unlisted fluoroscopic procedure (e.g., diagnostic, interventional) |
| 76497 | Unlisted computed tomography procedure (e.g., diagnostic, interventional) |
| 76498 | Unlisted magnetic resonance procedure (e.g., diagnostic, interventional) |
| 76499 | Unlisted diagnostic radiographic procedure |
| 76999 | Unlisted ultrasound procedure (e.g., diagnostic, interventional) |
| 77299 | Unlisted procedure, therapeutic radiology clinical treatment planning |
| 77399 | medical radiation physics, dosimetry and treatment devices, and special services |
| 77499 | therapeutic radiology treatment management |
| 77799 | clinical brachytherapy |
| 78099 | Unlisted endocrine procedure, diagnostic nuclear medicine |
| 78199 | Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine |
| 78299 | Unlisted gastrointestinal procedure, diagnostic nuclear medicine |
| 78399 | Unlisted musculoskeletal procedure, diagnostic nuclear medicine |
| 78499 | Unlisted cardiovascular procedure, diagnostic nuclear medicine |
| 78599 | Unlisted respiratory procedure, diagnostic nuclear medicine |
| 78699 | Unlisted nervous system procedure, diagnostic nuclear medicine |
| 78799 | Unlisted genitourinary procedure, diagnostic nuclear medicine |
| 78999 | Unlisted miscellaneous procedure, diagnostic nuclear medicine |
| 79999 | Radiopharmaceutical therapy, unlisted procedure |
D. Pathology - Laboratory Codes
Note: Some of the services below require precertification and are managed by Avalon Healthcare Solutions. The ordering physician may submit precertification requests and/or questions via Avalon’s Prior Authorization System (PAS) Portal or by calling 844-227-5769 (24/7). For more information, refer to the Genetic Testing Medical Policies: Avalon page on HMSA’s Provider Resource Center.
| Code | Description |
|---|---|
| 80299 | Quantitation of drug, not elsewhere classified. Note: the name of the drug the patient is being tested for must be indicated in box 19 of CMS 1500 claim form, in the remarks field, box 80 of UB-04 claim form, or included in the corresponding position in the 837 electronic claim. |
| 81099 | Unlisted urinalysis procedure |
| 85999 | Unlisted hematology and coagulation procedure |
| 86486 | Skin test; unlisted antigen, each |
| 86849 | Unlisted immunology procedure |
| 86999 | Unlisted transfusion medicine procedure |
| 87999 | Unlisted microbiology procedure |
| 88099 | Unlisted necropsy (autopsy) procedure |
| 88199 | Unlisted cytopathology procedure |
| 88299 | Unlisted cytogenetic study |
| 88399 | Unlisted surgical pathology procedure |
| 88749 | Unlisted in vivo (eg, transcutaneous) laboratory service |
| 89398 | Unlisted reproductive medicine laboratory procedure |
E. Codes from the Medicine Section
| Code | Description |
|---|---|
| 90399 | Unlisted immune globulin |
| 90749 | Unlisted vaccine/toxoid |
| 90779 | Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion |
| 90899 | Unlisted psychiatric service or procedure |
| 90999 | Unlisted dialysis procedure, inpatient or outpatient |
| 91299 | Unlisted diagnostic gastroenterology procedure |
| 92499 | Unlisted ophthalmological service or procedure |
| 92700 | Unlisted otorhinolaryngological service or procedure |
| 93799 | Unlisted cardiovascular service or procedure |
| 94799 | Unlisted pulmonary service or procedure |
| 95199 | Unlisted allergy/clinical immunologic service or procedure |
| 95999 | Unlisted neurological or neuromuscular diagnostic procedure |
| 96549 | Unlisted chemotherapy procedure |
| 96999 | Unlisted special dermatological service or procedure |
| 97039 | Unlisted modality (specify type and time if constant attendance) |
| 97139 | Unlisted therapeutic procedure (specify) |
| 97799 | Unlisted physical medicine/rehabilitation service or procedure |
| 99199 | Unlisted special service, procedure or report |
| 99600 | Unlisted home visit service or procedure |
F. E/M Codes
| Code | Description |
|---|---|
| 99429 | Unlisted preventive medicine service |
| 99499 | Unlisted evaluations and management service |
II. HCPCS for Miscellaneous Codes
I. Miscellaneous A Codes
| Code | Description |
|---|---|
| A4335 | Incontinence supply, miscellaneous |
| A4421 | Ostomy supply, miscellaneous |
| A4913 | Miscellaneous dialysis supplies, NOS |
| A9698 | Nonradioactive contrast imaging material, not otherwise classified, per study |
| A9699 | Radiopharmaceutical, therapeutic, not otherwise classified |
| A9900 | Miscellaneous DME supply, accessory, and/or service component of another HCPCS code |
| A9999 | Miscellaneous DME supply or accessory, not otherwise specified |
Miscellaneous E Codes
| Code | Description |
|---|---|
| E1399 | Durable medical equipment, miscellaneous |
| E2599 | Accessory for speech generating device, not otherwise classified |
Miscellaneous G Codes
| Code | Description |
|---|---|
| G0235 | Pet imaging, any site NOS |
Miscellaneous J Codes
| Code | Description |
|---|---|
| J0650 | Injection, levothyroxine sodium, not otherwise specified, 10 mcg |
| J0799 | FDA-approved prescription drug, only for use as HIV pre-exposure prophylaxis (not for use as treatment of HIV), not otherwise classified |
| J3490 | Unclassified drugs |
| J3590 | Unclassified biologics |
| J3591 | Unclassified drug or biological used for ESRD on dialysis |
| J7599 | Immunosuppressive drug, NOC |
| J7699 | NOC drugs, inhalation solutions, administered through DME |
| J7799 | NOC drugs, other than inhalation drugs, administered through DME |
| J8498 | Antiemetic drug, rectal suppository, NEC |
| J8499 | Prescription drug, oral non chemotherapeutic, NOS |
| J8597 | Antiemitic drug, oral, NOS |
| J8999 | Prescription drug, oral, chemotherapeutic, NOS |
| J9075 | Injection, cyclophosphamide, not otherwise specified, 5 mg |
| J9999 | NOC, antineoplastic drug |
Miscellaneous L Codes
| Code | Description |
|---|---|
| L8499 | Unlisted procedure for miscellaneous prosthetic services |
Miscellaneous M Codes
| Code | Description |
|---|---|
| M0235 | Intravenous infusion, monoclonal antibody products with an indication for postexposure prophylaxis or treatment of COVID-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, noninvasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, not otherwise classified, first dose |
| M0236 | Intravenous infusion, monoclonal antibody products with an indication for postexposure prophylaxis or treatment of COVID-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, noninvasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, not otherwise classified, second dose |
Miscellaneous Q Codes
| Code | Description |
|---|---|
| Q4050 | Cast supplies for unlisted types and material of casts |
| Q4051 | Splint supplies, misc. (includes thermoplastics, strapping, fasteners, padding and other supplies) |
| Q4082 | Drug or biological, NEC, Part B drug competitive acquisition program |
| Q0235 | Injection, monoclonal antibody products with an indication for postexposure prophylaxis or treatment of COVID-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, noninvasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, not otherwise classified, 1 mg |
| Q4431 | PMA skin substitute product, not otherwise specified (list in addition to primary procedure) |
| Q4432 | 510(k) skin substitute product, not otherwise specified (list in addition to primary procedure) |
| Q4433 | 361 HCT/P skin substitute product, not otherwise specified (list in addition to primary procedure) |
Miscellaneous S Codes
| Code | Description |
|---|---|
| S8189 | Tracheostomy supply, NOS |
Miscellaneous V Codes
HMSA has partnered with EyeMed, service date effective January 1, 2022. HMSA transitioned our current vision portfolio to a new vision benefit with EyeMed for the following line of business: Commercial, Akamai Advantage®, QUEST Integration, Fed 87, and HMSA Plan for Postal Service Employees. HMSA will continue to be the administrators for non-routine vision services through the members medical plan(s). For more information, please contact EyeMed at www.eyemedinfocus.com
Contact by phone:
For Providers 1-888-259-4344
| Code | Description |
|---|---|
| V2199 | Not otherwise classified - single vision lens |
| V2797 | Vision supply, accessory or component of another HCPCS vision code |
| V2799 | Vision service, miscellaneous |
| V5299 | Hearing service, miscellaneous |
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |