States Applicable to Alert: Hawaii, Nevada, Guam, American Samoa, Northern Mariana Islands, Northern California and Southern California

Background Information: Palmetto GBA requires an invoice for pricing for certain Radiopharmaceuticals (see article Radiopharmaceutical Drugs that Require an Invoice for Pricing previously posted on the Palmetto GBA Web site). For a limited time only, Palmetto GBA will send providers development letters asking for invoices for claims that are submitted without one.

Applies To Procedure Code(s):
A9455    A9504     A9512     A9517     A9527     A9536
A9545    A9546     A9550     A9552     A9554     A9567     A9568

Modifier(s): N/A

Remark /Reason Codes: N/A

MAC Action: As indicated above, prior to July 1, 2009 development letters were sent to providers requesting the invoice. Claims received on and after July 1, 2009, for the above procedure codes, that do not include an invoice will be rejected by Palmetto GBA. Rejected claims must be corrected and resubmitted as new claims.

Provider Action: None

Date Reported: May 4, 2009
Date Resolved: July 1, 2009