Using Unlisted Codes for Workers' Comp Services


Two Texas workers’ compensation-specific services, outpatient medical rehabilitation programs and chronic pain programs, use “unlisted” CPT codes. Unlisted CPT codes are those used for any service — such as these two — that no other American Medical Association CPT code lists specifically.

The Texas workers’ comp medical fee guidelines provide special commission modifiers in TAC 134.202(e)(9)  that you should be familiar with. When you use an unlisted CPT code for a commission-specific service, use the appropriate commission modifier in addition to any modifiers that Medicare requires for that CPT code. When you use an unlisted CPT code for other than commission-specific services, do not use commission modifiers. Bill noncommission-specific services according to Medicare billing policies.


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