2025 Invoice Pricing

Palmetto GBA prices some CPT® and HCPCS codes using invoices. 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 Palmetto GBA has 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 and Biologicals 

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

The codes in the following file are priced off invoice for 2025 dates of service: 2025 Jurisdiction J Invoice List.

Please see the Submitting Additional Documentation article for instructions on how to submit invoices.