Avoiding Denials on Priced Per Invoice Claims

Procedure codes that require pricing per invoice, must contain the below elements in Item 19 of the CMS-1500 claim form or its electronic equivalent for each line item submitted.

  • Total invoice price plus shipping cost (do not include handling or other fees)
  • If billing an unlisted code (codes ending in ***99) supply a description of the code
  • 'Invoice' or 'Inv' followed by the price in a currency format using a decimal
    • Examples:
      • Invoice $130 - claim priced at $1.30
      • Invoice $130.00 - claim priced at $130.00
      • Invoice 13000 - claim priced at $130.00
      • Invoice $13000 - claim priced at $130.00
      • Invoice $1,300 - claim priced at $1,300.00

If this required information is not submitted, the item will be denied as unprocessable.

Note: Total invoice price is the net amount a provider pays for an item/service, taking into account ALL discounts, rebates, refunds, or other adjustments*. In addition, Medicare will reimburse for shipping but no other additional fees (tax, handling fees, delivery fees, administrative fees).

X
 

L8600-L8679, L8681-L8699: If no amount is available within the DMEPOS fee schedule, submit an invoice price.

P9005-P9099: Submit an invoice price unless pricing is provided within a fee schedule

Skin substitute codes that are not priced off the ASP file.

Procedure Codes that Always Require an Invoice Cost

  • 86970
  • 86975
  • 86977
  • 89259
  • 89281
  • A2001
  • A2002
  • A2003
  • A2004
  • A2005
  • A2006
  • A2007
  • A2008
  • A2009
  • A2010
  • A4290
  • A4648
  • A9500
  • A9516
  • A9527
  • A9528
  • A9529
  • A9530
  • A9531
  • A9593
  • A9594
  • A9606
  • C1062
  • C1734
  • C1761
  • C1822
  • C1823
  • C1824
  • C1825
  • C1830
  • C1833
  • C1839
  • C1841
  • C2613
  • C2623
  • C2624
  • E0746
  • G0460 billed with
    Q0 or Q1 modifiers
  • L7510
  • L7520
  • L8688
  • Q0507
  • Q0508
  • Q0509
  • Q2026
  • Q3001
  • Q4050
  • Q4051
  • Q9955
  • Q9959
  • V2520
  • V2521
  • V2522
  • V2523
  • V2785
  • V2790

Procedure Codes that Require a Description and an Invoice

  • A4649
  • A4641
  • A9699
  • L8499
  • L8699

Providers must maintain an invoice copy in the patient's file and it must be made available to Noridian upon request.

  • A2001 effective 01/01/22
  • C1062 effective 01/01/21
  • C1823 effective 01/01/19
  • C1833 effective 01/01/22
  • A2002 effective 01/01/22
  • A2003 effective 01/01/22
  • A2004 effective 01/01/22
  • A2005 effective 01/01/22
  • A2006 effective 01/01/22
  • A2007 effective 01/01/22
  • A2008 effective 01/01/22
  • A2009 effective 01/01/22
  • A2010 effective 01/01/22

*References include but not limited to:

 

Last Updated Wed, 26 Oct 2022 14:56:04 +0000