Outpatient FAQ June 2013

on Wednesday, 05 June 2013. All News Items | FAQ

Date of Service Medical Unlikely Edits

Question:

Medicare recently announced the implementation of date of service medical unlikely edits (DOS MUEs) for some HCPCS/CPT codes. What does this mean for providers?

Answer:

  • These codes will not be paid if the total number of units for one date of service exceeds the MUE limit.
  • Codes exceeding the date of service MUE will not be paid even if reported on separate lines and appended with a modifier.
  • Medicare does not say which codes have date of service MUEs.


Utilizing the new MMP, Inc. HIQUP reports, MMP has been able to identify some of the HCPCS/CPT codes to which the new date of service edits appear to apply.

Code

Description

MUE Qty

37221

Iliac revasc w/stent

1

38206

Harvest auto stem cells

1

38207

Cryopreserve stem cells

1

64635

Destroy lumb/sac facet jnt

1

72265

Myelography l-s spine

1

74425

Contrst x-ray urinary tract

1

80053

Comprehen metabolic panel

1

80061

Lipid panel

1

80076

Hepatic function panel

1

82272

Occult bld feces 1-3 tests

1

82550

Assay of ck (cpk)

3

82553

Creatine mb fraction

3

83735

Assay of magnesium

4

84100

Assay of phosphorus

3

84156

Assay of protein urine

1

84436

Assay of total thyroxine

1

84484

Assay of troponin quant

3

85025

Complete cbc w/auto diff wbc

2

86140

C-reactive protein

1

86361

T cell absolute count

1

87400

Influenza a/b ag eia

1

87427

Shiga-like toxin ag eia

1

87493

C diff amplified probe

1

96365

Ther/proph/diag iv inf init

1

96374

Ther/proph/diag inj iv push

1

99212

Office/outpatient visit est

2

MMP, Inc. clients that purchase the new HIQUP product suite of reports will be able to identify claims with codes that deny for the lack of an appropriate modifier or because code units exceed a date of service MUE.

 

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