Tenn. Comp. R. & Regs. 0800-02-17-.06 - PROCEDURES FOR WHICH CODES OR VALUES ARE NOT LISTED

(1) If a procedure is performed which is not listed in the rate tables, the health care provider shall use an appropriate CPT® procedure code or revenue code, as applicable. The provider shall submit an explanation, such as copies of operative reports, consultation reports, progress notes, office notes or other applicable documentation, or description of equipment or supply (when that is the bill).

(2) The CPT® book contains procedure codes for unlisted procedures. These codes should only be used when there is no procedure code which accurately describes the service rendered. A special report is required. These services are reimbursed BR (By Report, see 0800-02-17-.03).

(3) Where codes or other reports are listed with a dollar amount in these Rules, conversion to RVUs may be calculated by dividing the listed dollar amount by the Medicare Conversion Factor effective on the date of service. The Tennessee Specific Conversion Percentages are not applied to these codes or charges.

Notes

Tenn. Comp. R. & Regs. 0800-02-17-.06

Public necessity rule filed June 5, 2005; effective through November 27, 2005. Public necessity rule filed November 16, 2005; effective through April 30, 2006. Original rule filed February 3, 2006; effective April 19, 2006. Amendment filed March 12, 2012; to have been effective June 10, 2012. The Government Operations Committee filed a stay on May 7, 2012; new effective date August 9, 2012. Repeal and new rules filed November 27, 2017; effective February 25, 2018. Amendments filed June 12, 2019; effective September 10, 2019. Administrative changes made to this chapter on September 10, 2019; "Tennessee Workers' Compensation Act" or "Act" references were changed to "Tennessee Workers' Compensation Law" or "Law." Amendments filed June 28, 2021; effective September 26, 2021. Amendments filed June 27, 2023; effective 9/25/2023.

Authority: T.C.A. §§ 50-6-204, 50-6-205, and 50-6-233 (Repl. 2005).