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
  • Priced in a currency format using a decimal
    • Examples:
      • Invoice $130 - price claim at $1.30
      • Invoice 13000 - price claim at $130.00
      • Invoice $13000 - price claim at $130.00
      • Invoice $130.00 - price claim at $130.00

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

X
 

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

Procedure Codes that Always Require an Invoice Cost

  • 86152
  • 86970
  • 86975
  • 86977
  • 88384
  • 89259
  • 89281
  • A4290
  • A4570
  • A4648
  • A4649
  • A9512
  • A9516
  • A9526
  • A9527
  • A9529
  • A9531
  • A9547
  • A9554
  • A9563
  • A9564
  • A9571
  • A9599
  • A9606
  • C1822
  • C1830
  • C1841
  • C2613
  • C2623
  • C2624
  • E0746
  • G0460 billed with
    Q0 or Q1 modifiers
  • J7326
  • L7500
  • L7510
  • L8680
  • L8688
  • P9021
  • P9035
  • P9037
  • P9051
  • P9053
  • P9054
  • P9056
  • P9057
  • P9058
  • Q0505
  • Q0507
  • Q0508
  • Q0509
  • Q2026
  • Q2027
  • Q3001
  • Q4049
  • Q4050
  • Q4051
  • Q4200
  • Q4201
  • Q4202
  • Q4203
  • Q4204
  • Q9551
  • Q9955
  • Q9959
  • 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.

 

Last Updated Jul 23, 2019