Affinity: HCPCS Code Q4159 Requires Invoice

Published 11/04/2021

When submitting claims for Affinity, an invoice must be submitted for payment/pricing consideration for dates of service between January 1 to June 30, 2021, and October 1 to December 31, 2021. Q4159 pays from the CMS Average Sales Price (ASP) Pricing File for dates of service between July 1, 2021, and September 30, 2021, therefore no invoice is needed for those dates.

HCPCS Code: Q4159

Documentation Requirements:

  • For electronic claims, submit the invoice via eServices or PWK
  • For paper claims, submit the invoice as an attachment to the claim

If an invoice is not submitted, HCPCS code Q4159 will be rejected and must be resubmitted as a new claim with the invoice.

More information on payment allowances and methodologies for drugs and biologicals that are not included in the ASP Medicare Part B Drug Pricing can be found in IOM Publication 100-04 Chapter 17 Drugs and Biologicals § 20.1.3 Exceptions to the Average Sales Pricing (ASP) Payment Methodology (PDF, 493 KB)

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