tci Medicare Compliance & Reimbursement - 2024 Issue Q1

Industry Notes: Review Which Codes Require Invoices, MAC Warns

Before you submit your Medicare claims, one Medicare Administrative Contractor (MAC) reminds that some CPT® and HCPCS codes also require an additional invoice — or you may find yourself in the denial zone. Here’s the scoop: Specific codes are priced via invoice, and “failure to submit an invoice, submitting unclear invoices or submitting incomplete invoices could result in claim rejections,” cautions Part B MAC Palmetto GBA in a Jan. 23 news alert. Caveat: “Contractor pricing is determined upon the receipt of a covered claim,” Palmetto says. What that means is that it can be...

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