When unlisted codes are reported on a CMS-1500 claim, what is submitted to clarify the services rendered?

When unlisted codes are reported on a CMS-1500 claim, a claim attachment is submitted to clarify the services rendered. Unlisted codes are used when there is not a specific code available to describe a procedure or service. To provide detailed information about the service performed and justify the payment, healthcare providers attach additional documentation along with the claim.

This documentation could include a narrative explanation of the service, relevant medical records, or other supporting information that clarifies the necessity and nature of the service in question. Including this detailed information helps insurers understand the context of the claim and assists in the proper adjudication process.

In contrast, source documents refer to original records like the patient’s chart and are not typically submitted with claims but may be reviewed by the payer if needed. Remittance advice is a document sent by the insurance company to the provider explaining the processing of the claim but does not accompany the claim. A documentation request usually pertains to requests made by the payer after the claim is submitted and is not something the provider would proactively submit with the original claim. Thus, the claim attachment is the appropriate method for providing supplementary information when using unlisted codes.