Process for supplying invoice amount on certain HCPCS codes -- Avoid rejected claims
To reduce provider burden, certain contractor-priced HCPCS codes no longer require a paper invoice.
When the invoice information is entered in the narrative field on a claim for any of the HCPCS codes listed below, it is not necessary to provide the actual paper invoice for these services.
The required narrative information includes:
- Invoice dollar amount and quantity for the drug or biological.
- Name of the drug or biological administered.
The dosage of the medication or the size of the biological administered.
- The route of administration if applicable.
Claims not containing information about the invoice or cost associated with the code(s) will reject as unprocessable.
How to report invoice amount
You must proactively enter the invoice information on your incoming claim.
- Obtain the total invoice cost for the patient and service. You must report the amount from the invoice that is applicable for the patient and service on the claim; you aren’t reporting the retail amount or amount you charge for the service.
- Enter the invoice amount on block 19 of the CMS-1500 paper claim form or its electronic equivalent of Loop 2400 Segment NTE02 in the following format (including cents):
- INV. $00.00 product name or description and size, quantity per invoice
Claim example
- The provider administered 6 square centimeters of the biological represented by code Q4176 (Neopatch, or therion, per square centimeter), therefore procedure code Q4176 was billed with a quantity of "6".
- The invoice showed $1140.00 for Neopatch Membrane 2cm x 3cm:
The invoice amount is the total amount a provider pays for an item or service, considering all discounts, rebates, refunds, or other adjustments to an item. You must maintain sufficient documentation in the patient's file in the event of a review.
The evaluation of codes for this list is an ongoing process. Be sure to check back frequently and subscribe to our eNews.
ASC device codes
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Blood product codes
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Drug codes
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- For more detailed information related to billing NOC codes (e.g., J7999), please review our Appropriate use of NOC codes when billing for drugs and biologicals article.
Vaccine codes
90635, 91323, Q2039
Low osmolar contrast material code
Q9951
High osmolar contrast material codes
Q9959, Q9964
Radiopharmaceutical codes
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Skin substitute codes
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Other HCPCS codes
A4220, A9292, A9293, G0555, Q3001, V2785, V2790