Unlisted Services
Radiology services not covered by listed Procedure-4 procedure codes should be billed with the appropriate unlisted Procedure-4 code. The following Procedure-4 unlisted codes require authorization on a Treatment Authorization Request (TAR):
Procedure-4 Code Description
76496 Unlisted fluoroscopic procedure (eg, diagnostic, interventional)
76497 Unlisted computed tomography procedure (eg, diagnostic, interventional)
76498 Unlisted magnetic resonance procedure (eg, diagnostic, interventional)
76499 Unlisted diagnostic radiographic procedure
Include a comprehensive report of the service billed in the Remarks field (Box 80)/Reserved for Local Use field (Box 19) of the claim or as an attachment to the claim.
Radiology services not covered by listed Procedure-4 procedure codes should be billed with the appropriate unlisted Procedure-4 code. The following Procedure-4 unlisted codes require authorization on a Treatment Authorization Request (TAR):
Procedure-4 Code Description
76496 Unlisted fluoroscopic procedure (eg, diagnostic, interventional)
76497 Unlisted computed tomography procedure (eg, diagnostic, interventional)
76498 Unlisted magnetic resonance procedure (eg, diagnostic, interventional)
76499 Unlisted diagnostic radiographic procedure
Include a comprehensive report of the service billed in the Remarks field (Box 80)/Reserved for Local Use field (Box 19) of the claim or as an attachment to the claim.
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