How should providers bill for different non-contracted items that have the same HCPCS Level II code (such as administration sets/extension sets) without the claim being denied or rejected for duplicate charges?
If the HCPCS Level II code has a price listed in the Medi-Cal provider manual (price on file), providers can submit one HCPCS Level II code with the total number of units that represent the various products that are being billed. A pricing attachment is not required for these claims. If the HCPCS Level II code does not have a price on file, an attachment must be included with the claim identifying each product description and price for each item. If the medical supply products have different rates, then providers may include separate service lines on the claim with the billed amount for each product (similar to billing for HCPCS codes with different amounts). When this happens, the claim will suspend for review of the invoice attachments and will be priced accordingly. Providers may also place the HCPCS Level II code on one service line with a total quantity and clearly identify each individual product billed under that single HCPCS Level II code and quantity on the attachment.
Related Questions
- When the provider determines what HCPCS Level II code will replace the local code on an existing TAR/SAR, will the field office accept the HCPCS Level II code listed on the new TAR/SAR without further documentation?
- If a provider enters the HCPCS Level I, II or III code, units and/or NDC correctly, but does not enter the unit of measurement correctly, will that line item be denied?
- Many of the Level II HCPCS codes (L codes) do not describe the splints that I am fabricating. How do I choose the proper code?
