March 18, 2025
Billing Not Otherwise Classified (NOC) HCPCS Code
Correct Healthcare Common Procedure Coding System (HCPCS) coding is imperative when providing Part B services. Providers are required to correctly code for the item or service billed. An item/service is correctly coded when it meets all the coding guidelines listed in CMS HCPCS guidelines, LCDs, LCD-related articles, or Part B MAC articles. Medicare will deny services reported with not otherwise classified (NOC) codes if valid codes are available for item. CGS will not correctly code a billed NOC code when a valid HCPCS code is available.
Items billed with any HCPCS code with a narrative description that indicates miscellaneous, NOC, unlisted, or non-specified, must also include a narrative in the NTE 2400 (line note) or NTE 2300 (claim note) segments of the American National Standard Institute (ANSI X12) format. These narratives may also be added in Item 19 of the CMS-1500 claim form. Enter as much information as possible to ensure prompt processing of the claim.
The NTE 2400 field of an electronic claim is limited to 80 characters; therefore, suppliers are encouraged to use the following list of Suggested Abbreviations List for Submitting Narrative Information to condense all of the required information into this field.
Required Narrative added to claim for NOC coded item:
- For correct processing, claim must Indicate what it is, what is it for, what is Provider Price List amount
- Description of item or service
- Manufacturer name
- Product name, model name and number
- Provider Price List amount
- HCPCS code of related item (if applicable)
Remember, space is limited so ensure what is required is entered in the narrative.
Denials
- If narrative information is not added to claim, claim will deny as missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code and must be corrected and rebilled as denial will indicate there are no appeal rights because the claim is unprocessable
- If claim processed and denied, for reason other than above, request redetermination with all documentation to support medical necessity
- Medical necessity for item/service (medical records)
Gap Filling
The fee schedule for items for which charge data is not available or published is calculated based on:
- Fee schedule amounts for comparable item/service
- Provider price lists
- Manufacturers wholesale price
For more information on the pricing methodology used for unpublished fee schedules review CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 23, Fee Schedule Administration and Coding Requirements.
Individual Local Coverage Determination (LCD) and related articles will have specific NOC coding information. Visit CGS's website for specific LCDs for policy specific NOC codes.