Services and Circumstances that Require Additional Documentation

Published 02/07/2025

The submission of additional documentation is required only when certain CPT®/HCPCS codes are billed, or when additional documentation is needed for Palmetto GBA to process and/or price a service.

Note: Additional documentation should not be submitted for services or circumstances other than those listed below. Documentation received for services or circumstances other than those listed (or if specifically requested by Palmetto GBA through the additional documentation request [ADR] process) will not be acknowledged and matched with your claim.

Important: When submitting one of the CPT®/HCPCS Codes below and the code is not presented in the procedure code selection box in eServices, additional documentation can be submitted via the fax cover sheet or PWK fax cover sheet until the procedure code is available in eServices.

CPT®/HCPCS Codes

Note: CPT® codes and modifier begin with a numeric character and HCPCS codes and modifiers begin with an alpha character. 

CPT® Codes

Table 1. CPT Codes

Code Range 00000 – 09999
01999 0408T 0409T
0410T 0411T 0412T
0413T 0414T 0415T
0416T 0417T 0418T
0660T 0661T 0752T
0753T 0753T  
Code Range: 00000 – 09999
01999
Code Range: 10000 – 19999 
15999 17999 19499
Code Range: 20000 – 29999
20999 21089 21110
21299 21499 21899
22899 22999 23929
24999 25999 26989
27299 27599 27899
28899 29799 29999
Code Range: 30000 – 39999
30999 31299 31599
31899 32999 33999
36299 37501 37799
38129 38589 38999
39499 39599 o
Code Range: 40000 – 49999
40799 40899 41599
41899 42299 42699
42999 43289 43499
43659 43999 44238
44799 44899 44979
45399 45499 45999
46999 47379 47399
47579 47999 49329
49659 49999  
Code Range: 50000 – 59999
50549 50949 51999
53899 54699 55559
55899 55970 55980
58578 58579 58679
58999 59897 59898
59899    
Code Range: 60000 – 69999
60659 60699 64999
66983 66987 66988
66999 67299 67399
67599 67999 68399
68899 69399 69799
69949 69979  
Code Range: 70000 – 79999
76120 76125 76496
76497 76498 76499
76999 77299 77399
77499 77799 78099
78199 78299 78399
78429 78430 78431
78432 78433 78434
78499 78599 78699
78799 78999 79999
Code Range: 80000 – 89999
80299 81099 81400
81401 81402 81403
81404 81405 81406
81407 81408 81479
81599 82664 84999
85999 86486 86812
86813 86816 86817
86821 86822 86825
86826 86849 86999
87154 87299 87483
87798 87799 87899
87999 88099 88199
88299 88399 88749
89240 89398  
Code Range: 90000 – 99999
90284 90399 90654
90655 90669 90749
90899 90999 91299
92499 92700 93799
93998 94799 95199
95706 95707 95709
95710 95711 95712
95713 95714 95715
95716 95999 96379
96549 96999 97039
97139 97151 97152
97153 97154 97155
97156 97157 97158
97799 99082 99199
99429 99499 99600
Code Range: 0000T – 0999T
0159T 0188T 0189T
0190T 0195T 0196T
0337T 0346T 0359T
0360T 0361T 0363T
0364T 0365T 0366T
0367T 0368T 0369T
0370T 0371T 0372T
0374T 0387T 0388T
0389T 0390T 0391T
0406T 0407T 0479T
0480T 0483T 0505T
0506T 0507T 0508T
0509T 0510T 0511T
0512T 0513T 0514T
0515T 0516T 0517T
0518T 0519T 0520T
0521T 0522T 0523T
0524T 0525T 0526T
0527T 0528T 0529T
0530T 0531T 0532T
0533T 0534T 0535T
0536T 0537T 0538T
0539T 0540T 0541T
0542T 0543T 0544T
0545T 0546T 0547T
0548T 0549T 0550T
0551T 0552T 0553T
0554T 0555T 0556T
0557T 0558T 0559T
0560T 0561T 0562T
0563T 0567T 0569T
0570T 0571T 0572T
0573T 0574T 0575T
0581T 0582T 0583T
0584T 0585T 0586T
0587T 0591T 0592T
0593T 0594T 0598T
0599T 0600T 0601T
0609T 0610T 0611T
0612T 0613T 0730T
0737T     

HCPCS Codes

Table 2. HCPCS Codes.
Code Range: A0000 – A9999
A0999 A2019 A4290
A4563 A4640 A4641
A4642 A4648 A4650
A9501 A9504 A9508
A9509 A9516 A9517
A9527 A9529 A9532
A9536 A9542 A9543
A9544 A9545 A9546
A9547 A9550 A9553
A9554 A9557 A9559
A9563 A9564 A9566
A9567 A9570 A9571
A9572 A9582 A9584
A9586 A9597 A9598
A9699 A9999  
Code Range: C0000 – C9999
C1823 C1824 C1826
C9399    
Code Range: D0000 – D9999
D2999 D5899 D6199
D7999 D9999  
Code Range: E0000 – E9999
E1399
Code Range: G0000 – G9999
G0308 G0309  
Code Range: J0000 – J9999
J0120 J0400 J0475
J0665 J0715 J0735
J0883 J0945 J1060
J1094 J1130 J1170
J1230 J1330 J1435
J1457 J1710 J1725
J1729 J1810 J1890
J1990 J2180 J2278
J2320 J2650 J2795
J2797 J2910 J2950
J3010 J3303 J3305
J3310 J3398 J3400
J3472 J3490 J3590
J3591 J7170 J7199
J7309 J7315 J7629
J7799 J7999 J9044
J9057 J9219 J9999
Code Range: J0000 – J9999
J0120 J0400 J0475
J0715 J0735 J0833
J0945 J1060 J1094
J1130 J1170 J1230
J1330 J1435 J1457
J1710 J1725 J1729
J1810 J1890 J1990
J2180 J2278 J2320
J2650 J2795 J2797
J2910 J2950 J3010
J3303 J3305 J3310
J3398 J3400 J3472
J3490 J3590 J3591
J7170 J7199 J7309
J7315 J7629 J7799
J7999 J9044 J9057
J9219 J9999  
Code Range: L0000
L7510 L8499 L8604
L8608 L8679 L8699
L9900      
Code Range: Q0000 – Q9999
Q0507 Q0508 Q0509
Q2028 Q2035 Q2036
Q2038 Q2039 Q3001
Q4050 Q4051 Q4116
Q4125 Q4130 Q4135
Q4136 Q4142 Q4145
Q4149 Q4153 Q4157
Q4159 Q4163 Q4165
Q4167 Q4179 Q4182
Q4183 Q4190 Q4198
Q4200 Q4202 Q4209
Q4211 Q4214 Q4216
Q4220 Q4228 Q4237
Q4240 Q4249 Q4250
Q4255 Q9953 Q9954
Q9962    
Code Range: V0000 – V9999
V2785 V2799 V5299

Important Note: While Palmetto GBA has made every attempt to identify all services that will require additional documentation, the above list is not all-inclusive due to the nature of health care and changes in coding and pricing requirements.

Palmetto GBA Reserves the Right to Require Additional Documentation for Any Claim
Claims rejected with the following Claim Adjustment Reason Codes (CARCs) and Remittance Advice Remark Codes (RARCs) identified on a remittance advice would indicate documentation is required and the claim should be resubmitted as a new claim with the necessary documentation. Providers receiving these rejections for lack of documentation should make note and include documentation with any claim submitted in the future for the service(s).

Table 3. Claim Adjustment Reason Codes.
CARC RARC
251 — The attachment or other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. N233 — Incomplete or invalid operative note or report. 
251 — The attachment or other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. N705 — Incomplete or invalid documentation. 
252 — An attachment or other documentation is required to adjudicate this claim or service. M23 — Missing invoice.
252 — An attachment or other documentation is required to adjudicate this claim or service. M29 — Missing operative, note or report.
252 — An attachment or other documentation is required to adjudicate this claim or service. N706 — Missing documentation.

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