OA-189: No Specific Procedure Code for Service Billed

What Does OA-189 Mean?

With OA (Other Adjustments), the unlisted code issue was flagged during coordination of benefits. Resolve the coding issue and resubmit through the proper COB sequence.

CARC 189 appears when the claim was submitted with an unlisted procedure code (often ending in 99 for CPT codes) and the payer either believes a more specific code should have been used, or the required supporting documentation for the unlisted code was not included. When providers use unlisted codes, payers typically require a detailed description of the service, an operative report, and comparable procedure pricing to process the claim.

Unlisted codes are legitimate when no specific CPT or HCPCS code exists for the service performed, but they require significantly more documentation than standard codes. The payer cannot determine appropriate reimbursement without understanding exactly what was done and how it compares to other coded procedures.

How to Resolve

1. Identify the correct code or prepare documentation Either find a specific code or prepare comprehensive documentation for the unlisted code.
2. Resubmit through the COB sequence Submit the corrected or documented claim to the primary payer first.

How to Prevent OA-189

• Verify unlisted code documentation requirements for each payer in the coordination chain

Also Filed As

The same CARC 189 may appear with different Group Codes:

Related Denial Codes