Invoices Must Be Submitted for Certain Drug and Biological Codes: January Through March 2022

Published 04/14/2022

IOM Publication 100-04 Chapter 17 Drugs and Biologicals 20.1.3 Exceptions to Average Sales Price (ASP) Payment Methodology (PDF) gives Medicare Administrative Contractors (MACs) discretion to use invoice or WAC pricing when The Centers for Medicare and Medicaid Services (CMS) does not provide a payment limit on the ASP file. 

The following codes require invoices at this time.

CPT® Codes CPT® Codes CPT® Codes CPT® Codes CPT® Codes
90284 A9547 J2180 Q4135 Q4204
90654 A9548 J2320 Q4136 Q4209
90655 A9550 J2650 Q4138 Q4210
90657 A9551 J2910 Q4139 Q4211
90660 A9553 J2950 Q4140 Q4212
90661 A9554 J3303 Q4142 Q4214
90669 A9555 J3310 Q4143 Q4215
90749 A9556 J3400 Q4146 Q4216
HCPCS Codes A9557 J3472 Q4147 Q4217
A4290 A9558 J7309 Q4149 Q4220
A4641 A9559 J7315 Q4150 Q4221
A4642 A9561 J7329 Q4155 Q4228
A4648 A9562 J9118 Q4157 Q4229
A4650 A9563 J9219 Q4161 Q4230
A9501 A9564 L7510 Q4164 Q4232
A9504 A9566 L8604 Q4165 Q4233
A9508 A9567 L8699 Q4167 Q4234
A9509 A9570 L9900 Q4168 Q4235
A9510 A9571 Q2028 Q4173 Q4236
A9513 A9572 Q2035 Q4174 Q4237
A9515 A9580 Q2039 Q4175 Q4238
A9516 A9582 Q3001 Q4178 Q4239
A9517 A9600 Q4100 Q4179 Q4240
A9524 A9604 Q4103 Q4182 Q4241
A9526 A9999 Q4107 Q4183 Q4242
A9527 C1822 Q4108 Q4184 Q4245
A9529 J0120 Q4112 Q4185 Q4247
A9530 J0400 Q4113 Q4188 Q4248
A9531 J0833 Q4114 Q4190 Q4249
A9532 J0945 Q4116 Q4191 Q4250
A9536 J1130 Q4118 Q4192 Q4255
A9542 J1330 Q4125 Q4193 Q9953
A9543 J1435 Q4126 Q4198 Q9954
A9544 J1457 Q4128 Q4200 Q9962
A9545 J1890 Q4130 Q4202 Q9983
A9546 J1990 Q4134 Q4203 V2785

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