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Printed Date: 9/22/2015
It has been determined the units of service are in excess of the medically reasonable daily allowable frequency for HCPCS with an MAI of 1. This edit is bypassed when reporting a 55 CPT modifier.
Explanation and Suggestion:
Excess charges due to units of service greater than the maximum allowable; may not be billed to the beneficiary and cannot be waived or subject to an ABN.
CMS developed MUEs to reduce the paid claims error rate for Part B claims. The MUE for a HCPCS/CPT code is the maximum units of service that (under most circumstances) would be reported for a beneficiary on a single date of service. Please note all HCPCS/CPT codes have an MUE edit. See MLN SE1422 (PDF, 392 KB) and Medically Unlikely Edits.
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Last Updated: 12/27/2018