cpt 99199, cpt code 99199, 99199 cpt code

CPT Code 99199 | Description, Procedure & Billing Guidelines (2022)

Use CPT 99199 for billing unlisted medicine services or special procedures not precisely defined by more specific CPT codes.

1. What Is CPT Code 99199?

CPT 99199 covers medicine procedures or special services not defined by a more specific CPT code. The 99199 CPT code is an unlisted procedure.

2. Description

The CPT book defines CPT code 99199 as follows: “Unlisted special service, procedure or report.”

3. Procedure

The 99199 CPT code is an unlisted procedure and represents a medicine service or procedure that is not precisely defined by any other CPT code.

Double-check with the provider, who performed the unlisted medicine procedure, that all the necessary documentation is included in the claim.

4. Billing Guidelines

You can not bill a CPT code for a medicine service/procedure that only approximates that service. Therefore, CPT created unlisted procedural codes (for example, CPT 99199) to bill procedures not defined by other codes.

Because CPT code 99199 is an unlisted procedure, you need to submit a letter to the claim explaining why you chose this code instead of a more specific one.

You can add similar medicine codes and compare the provided services to those codes to justify your unlisted procedure claim.

Operative notes can also be included in the claim and other documentation that you or the provider consider relevant. This will strengthen the claim of billing the medicine procedure/service as an unlisted procedure CPT code 99199.

Since CPT 99199 is an unlisted procedure, the payers will check the claim case-by-case before determining a payment based on the documentation and the cover letter.

5. Resources

CPT Professional 2022

https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=56025

https://www.aapc.com/blog/24481-avoid-denials-when-reporting-unlisted-services-and-procedures/

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