MedicaidDocumentationMedium impact
Reminders Regarding Use of Unlisted, Not Otherwise Classified, Procedure Codes
Wisconsin Medicaid (ForwardHealth)·WI·Medical Policy
We identified it
Jun 20, 2026
Summary
This policy clarifies documentation requirements for unlisted procedure codes in Wisconsin Medicaid programs. When no specific CPT/HCPCS code exists for a service, providers must use unlisted codes with proper documentation describing the procedure and justifying why other codes aren't appropriate.
Action Required
Immediately: Billing team must establish workflow for unlisted procedure codes - require providers to document procedure name/description and justify why other codes aren't appropriate before billing. Update claim submission process to include supporting documentation in Element 19 for paper claims or Notes field for electronic claims. Train staff to check if unlisted codes require prior authorization using ForwardHealth fee schedules.