All Provider Bulletin 411: Documentation Required for Review of Unlisted CPT Codes

Immediately: Billing team must download the Unlisted CPT Code Form from mass.gov and update workflow procedures. When submitting claims with unlisted CPT codes, staff must attach the completed form, supporting medical records explaining why no existing CPT code applies, and use delay reason code 11 in the billing system. Provider must document procedure details, medical necessity, time, effort, and complexity. Claims without the form and delay code 11 will be denied.