Who requires a special report when using an unlisted code?

When using an unlisted code in medical billing, a special report is typically required by third party payers. This is necessary because unlisted codes do not provide specific information about the services rendered and can lead to confusion regarding payment. The report must include detailed information about the service, the rationale for using an unlisted code, and any necessary documentation that justifies the procedure or service provided. This additional context is essential for the payer to make an informed decision regarding reimbursement.

The other options, while relevant in the broader context of coding and billing, do not specifically require the submission of a special report when an unlisted code is utilized. The AMA (American Medical Association) provides guidelines and updates regarding coding practices but does not enforce reporting requirements. The CPT manual serves as a reference for coding but does not dictate actions regarding third party payers. The National Center for Healthcare focuses more on policy and regulation rather than direct billing processes. Therefore, the requirement for a special report originates primarily from the needs of third party payers to assess claims accurately.