Radiopharmaceuticals Invoice or Acquisition Cost Submission Reminder

National Government Services has identified situations where claims are being submitted for radiopharmaceuticals without an invoice or acquisition cost provided.

For services that do not have established pricing, like radiopharmaceuticals, it is mandatory that we receive the invoice pricing or the acquisition cost from the provider for that drug that is being billed.; If we do not receive this information, the claim is considered an incomplete submission and we cannot continue processing of the claim.

Please remind staff members responsible for billing radiopharmaceuticals to bill with the invoice or acquisition cost on the claim submission to Medicare. The reporting of this information would be placed in the NTE Segment of Loop 2400 for the claim line on which the radiopharmaceutical is billed.

Also, please remember to code the units appropriately based on the HCPCS description for the code. If the code is defined at 1 cc and you have provided 2 cc then you would bill 2 units of service.

Posted 5/7/2020