Billing and Describing Not Otherwise Classified (NOC) Codes

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.

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.

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To properly reimburse noc services, providers must include the following:


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