2026 Invoice Pricing

Published 03/27/2026

Palmetto GBA prices some Current Procedural Terminology® (CPT®) and Healthcare Common Procedure Coding System (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 receipt of a covered claim. While Palmetto GBA has made every attempt to identify all services that require invoices to price, the list is not all-inclusive due to the nature of health care and changes in coding and pricing requirements.

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 Medicare Administrative Contractors discretion to use invoice or Wholesale Acquisition Cost (WAC) pricing when CMS does not provide a payment limit on the ASP file. 

The codes in this file are priced off invoice for 2026 dates of service: 2026 JM Invoice Code List (XLSX).

Please see Electronic Claims and Additional Documentation for instructions on how to submit invoices.


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