Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: November 18, 2014

Program Area: Distributed Data Collection (DDC) for RA Including HCRP/EDGE Server

Question: In a situation where there may be a clinical-only encounter, such as a nurse visit that would not be accepted by an issuer's billing system, is there a default Current Procedural Terminology (CPT) or procedure code that can be used for that record if the record does not have one (1) of the valid CPT or procedure codes present?

Answer: No, it has to be a valid Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code on any services that are provided. The CPTs and HCPCS will be validated against the current American Medical Association (AMA) coding, so an appropriate code for the service must be used.

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