Avoiding Denials on Priced Per Invoice Claims - JF Part B
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
- 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).
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
- G0460 billed with
Q0 or Q1 modifiers
Procedure Codes that Require a Description and an Invoice
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: Publication # 15-1, Chapter 8, Section 804; Medicare Learning Network (ICN MLN4649244) January 2021; 42 U.S.C. § 1320a-7b(b)(3); 42 CFR § 1001.952; SSA Section 1128J(d)
Last Updated Wed, 13 Jul 2022 15:20:50 +0000