Submitting Claims for Amounts Greater Than $99,999.99

Part B claims are limited to a maximum of $99,999.99 per claim due to field size limitations. Providers will need to submit separate claims when services exceed this threshold amount. Claims containing a dollar amount greater than $99,999.99 will be rejected.

When There Are Multiple Dates of Service 
If the charges involve multiple dates of service, submit the dates of service on separate claims that are less than $99,999.99 in total on each claim.

When There Is Only One Date of Service
If the charges are for the same date of service, submit the charges and quantity billed on separate claims that are less than $99,999.99 in total on each claim.

For claims submitted electronically, add a comment in the narrative: Loop 2300, or 2400, NTE, 02 indicating what number the claim is of the total number submitted for the specific service and the total money amount billed for all the claims combined. 

Example: Combined total for one date of service = $125,000 

• 1 of 3 claims, Billing Total of $125,000
• 2 of 3 claims, Billing Total of $125,000
• 3 of 3 claims, Billing Total of $125,000

Be sure the charges and quantity billed are not exactly the same on each claim when you need to take this approach. This will prevent the system from assuming the claims are duplicates.

Drugs and Biologicals
Please pay careful attention to the quantity billed when a drug or biological code has to be submitted on separate claims to ensure it appropriately expresses how much was administered. HCPCS modifiers that identify discarded drug amounts or attesting that none of the drug was discarded must be used correctly when separating claims under these circumstances.

References

• HCPCS Modifier JW
• HCPCS Modifier JZ 

Important Note
If the calculated quantity billed exceeds the total units indicated for the specific HCPCS code, the reimbursement amount may be calculated incorrectly. That is, the total payment allowance on a single detail line item cannot exceed $99,999.99. It is important to confirm the quantity billed is accurate prior to claims submission. 

Unclassified or Not-Otherwise-Classified (NOC) Drug Codes
When using unclassified and NOC drug codes, it is critically important that it is clear how much of the drug is being billed under each separate claim. Please provide the drug name, the dose being billed for the claim, the total dose administered, and National Drug Code (NDC). This will help us review and price your claim correctly. 

When supporting documentation is needed, it should also be indicated on each claim submitted. Please see Unclassified or Not Otherwise Classified (NOC) Drug Codes: Rejected if Not Submitted Correctly for more information.