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March 24, 2020

Submitting Claims When the Billed Amount Exceeds $99,999.99

The Standard Companion Guide for Health Care Claim: Professional (837P)PDF clarifies and specifies data content when exchanging transactions electronically with Medicare. One of the general rules pertaining to an 837P (Part B electronic claim) transaction is the maximum number of characters submitted in any dollar amount field is seven characters. Claims containing a dollar amount in excess of 99,999.99 will be rejected.

For claims you have for services that exceed this amount, they will have to be submitted on separate claims as follows:

Claim 1

  • Submit the service with an acceptable dollar amount (< 99,999.99.)
  • In the documentation field, identify this as, "Claim 1 of 2; Dollar amount exceeds charge line amount."

Claim 2

  • Submit the service with CPT modifier 59.
  • Enter the charge as the remaining dollar amount.
  • In the documentation field, identify this as, "Claim 2 of 2; Remaining dollar amount from Claim 1 amount exceeds charge line amount."

If you do not note in the documentation field the reason the claim is split this way, it will be denied as a duplicate.

Also, when splitting the charge of the service, be sure the dollar amounts are slightly different, as this will prevent the system from assuming the two claims are an exact duplicate.

  • For example, if the charge for a service is $100,000.00, submit the charge on Claim 1 as $51,000.00; on Claim 2 submit the charge as $49,000.00. 

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