Invoices Must Be Submitted for Certain Drug and Biological Codes: July Through September 2022

Published 06/28/2022

The Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual Publication 100-04 Chapter 17 Drugs and Biologicals 20.1.3 Exceptions to Average Sales Price (ASP) Payment Methodology gives Medicare contractors discretion to use invoice or Wholesale Aquisition Costs (WAC) pricing when CMS does not provide a payment limit on the ASP file. The codes below require invoices at this time.

Note: CPT® codes and modifiers begin with a numeric character and HCPCS codes and modifiers begin with an alpha character.

Drug and Biological Codes

90284

A9545

J1435

Q4113

Q4191

90654

A9546

J1457

Q4114

Q4193

90655

A9547

J1890

Q4116

Q4198

90657

A9548

J1990

Q4117

Q4200

90660

A9550

J2180

Q4118

Q4204

90661

A9551

J2320

Q4125

Q4209

90669

A9553

J2650

Q4126

Q4211

90749

A9554

J2910

Q4128

Q4214

A4290

A9556

J2950

Q4130

Q4216

A4641

A9557

J3303

Q4132

Q4220

A4642

A9558

J3310

Q4134

Q4221

A4648

A9559

J3400

Q4135

Q4228

A4650

A9562

J3472

Q4136

Q4229

A9501

A9563

J7309

Q4138

Q4236

A9504

A9564

J7315

Q4140

Q4237

A9508

A9566

J9118

Q4142

Q4238

A9509

A9567

J9219

Q4143

Q4239

A9510

A9570

L7510

Q4146

Q4240

A9515

A9571

L8604

Q4147

Q4241

A9516

A9572

L8699

Q4149

Q4242

A9517

A9580

L9900

Q4150

Q4248

A9524

A9582

Q0507

Q4157

Q4249

A9526

A9600

Q0508

Q4161

Q4250

A9527

A9604

Q0509

Q4164

Q4255

A9529

A9999

Q2028

Q4165

Q9953

A9530

C1822

Q2035

Q4167

Q9954

A9531

J0120

Q2039

Q4175

Q9962

A9532

J0400

Q3001

Q4179

Q9983

A9536

J0833

Q4100

Q4182

V2785

A9542

J0945

Q4103

Q4183

 

A9543

J1130

Q4107

Q4184

 

A9544

J1330

Q4108

Q4190

 

Please note that failure to submit an invoice, submitting unclear invoices, or submitting incomplete invoices could result in claim rejections.


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