Reporting An Unlisted CPT Code

Question:

What is needed to report an unlisted CPT code?

Answer:

To report an unlisted CPT code, you must first make certain that no code exists that represents the procedure in its entirety or with a modifier that would represent what was performed (e.g., modifier 52 for reduced services). Once it is determined that there is no existing code to represent the work, choose a code from the appropriate anatomical section of CPT, the appropriate approach (i.e. open vs laparoscopic), and compare the unlisted code to another code that most closely resembles the anatomical area, approach (if possible) and work involved to accurately compare RVUs and reimbursement expectations.

*This response is based on the best information available as of 2/13/25.