What is an “unlisted procedure code” in the CPT system?

An unlisted procedure code in the Current Procedural Terminology (CPT) system is utilized when a specific procedure or service does not have a designated code. This situation often arises for new or unique procedures that have not yet been assigned a specific code or when a procedure is so specialized that it does not fit into established categories.

When billing or coding using an unlisted procedure code, the healthcare provider must provide detailed documentation that describes the procedure performed, including its necessity and the context in which it was used. This allows insurers and payers to understand the service rendered and helps in processing the claim. The use of such codes ensures that healthcare providers can report their services accurately, even in the absence of a traditional code, thereby ensuring proper reimbursement and records.

In contrast, the other answer choices refer to different concepts. One pertains to established and widely recognized procedures, another incorrectly suggests that the code indicates a procedure was not performed, and the last choice implies the code is limited to clinical trial procedures, which does not accurately reflect the broader application of unlisted codes in various clinical settings.