Last Modified: 6/25/2020
Location: FL, PR, USVI
Business: Part B
To reduce provider burden, First Coast Service Options, Inc. (First Coast) has implemented a new process for certain biologicals and radiopharmaceuticals that allows you to proactively enter the invoice information on your incoming claim. As long as the information is submitted correctly for the codes provided below, we no longer issue an additional documentation request (ADR) asking for the invoice amount.
The Healthcare Common Procedure Coding System (HCPCS) codes included in this initiative are listed below as well as the effective dates. This new process is applicable only for these codes and only on claims that are processed on the corresponding effective dates.
• Obtain the total invoice cost for the patient and service. You must report the amount from the invoice that is applicable for the patient and service on the claim; you are not submitting the retail amount or amount you charge for the service.
• Enter the invoice amount on block 19 of the CMS-1500 paper claim form or its electronic equivalent of Loop 2400 Segment NTE02 in the following format (including cents):
• INV. $00.00
If you do not list the information appropriately on the claim, or if the information is missing, we will send an ADR to you requesting the invoice. We will also monitor these claims on a post payment basis to ensure accurate claims processing.
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Skin substitute codes processed on or after December 29, 2018:
Q4103, Q4112, Q4122, Q4124, Q4125, Q4126, Q4127, Q4128, Q4130, Q4134, Q4135, Q4136, Q4137, Q4138, Q4140, Q4141, Q4142, Q4143, Q4146, Q4147, Q4150, Q4151, Q4152, Q4154, Q4157, Q4158, Q4159, Q4160, Q4161, Q4163, Q4164, Q4165, Q4166, Q4167, Q4170, Q4175, Q4176, Q4178, Q4179, Q4180, Q4181, Q4182
Radiopharmaceutical codes processed on or after December 29, 2018:
A4642, A9501, A9503, A9504, A9508, A9509, A9512, A9516, A9526, A9527, A9528, A9529, A9530, A9531, A9532, A9536, A9538, A9539, A9540, A9541, A9542, A9544, A9545, A9546, A9550, A9553, A9557, A9559, A9563, A9564, A9566, A9567, A9569, A9570, A9571, A9572, A9580, A9587, A9588, A9599
Skin substitute codes processed on or after January 1, 2019:
Q4183, Q4184, Q4188, Q4190, Q4191, Q4193, Q4197, Q4198, Q4200, Q4201, Q4203, Q4204
Skin substitute codes processed on or after October 1, 2019:
Q4205, Q4209, Q4210, Q4211, Q4212, Q4214, Q4216, Q4217, Q4218, Q4219, Q4220, Q4221, Q4222
Skin substitute codes for services rendered on or after July 1, 2020:
Q4113, Q4115, Q4139, Q4155, Q4168, Q4171, Q4174, Q4192, Q4202, Q4227, Q4228, Q4229, Q4230, Q4233, Q4235, Q4236, Q4237, Q4238, Q4239, Q4240, Q4241, Q4242, Q4244, Q4245, Q4246, Q4247, Q4248
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