2023 Invoice Pricing

We  price some CPT® and HCPCS codes using invoices. Please note that failure to submit an invoice, submitting unclear invoices or submitting incomplete invoices could result in claim rejections.

New Codes and Code Changes

Contractor pricing is determined upon the receipt of a covered claim. While we have made every attempt to identify all services that require invoices to price, the nature of health care and changes in coding and pricing requirements, the list is not all-inclusive.

Drugs & Biologicals 

IOM Publication 100-04, Chapter 17 (PDF) Drugs and Biologicals, Section 20.1.3 Exceptions to Average Sales Price (ASP) Payment Methodology gives MACs discretion to use invoice or Wholesale Acquisition Cost (WAC) pricing when CMS does not provide a payment limit on the ASP file. 

The codes in this file (XLSX) are priced off invoices for 2023 dates of service.