Avoiding Denials on Priced Per Invoice Claims: Additional Codes – Effective August 15, 2016

MAC JF for Arizona, Alaska, Idaho, Oregon, Montana, North Dakota, South Dakota, Utah, Washington, Wyoming
MAC JE for California, Nevada and Hawaii

There are certain laboratory procedure codes that require pricing per invoice. Claims containing these codes must include the invoice price plus shipping cost as well as a code description for unlisted codes within Item 19 of the CMS-1500 claim form or its electronic equivalent. Effective August 15, 2016, additional codes will be added to this list. See the complete listing on the Procedure Codes that Always Require an Invoice Cost webpage. If this required information is not submitted, the item will be denied as unprocessable.

Source: https://med.noridianmedicare.com/web/jfb/topics/claim-submission/submission-errors-solutions/avoiding-denials-on-priced-per-invoice-claims