Please Note: There is no Medicare information on our corporate website. Please select a specific contract in the 'Search Within' box for Medicare related information.
© 2019 Palmetto GBA, LLC
We frequently update our articles to reflect the latest changes and updates to Medicare, and strongly recommend you visit this article at link below to confirm you have the latest version.
Published Date:12/27/2018
Printed Date: 9/22/2015
URL: http://palmgba.com/marlowe/redesign6/article.html
FISS Narrative 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.
We value your opinion and want to provide the highest-quality and most relevant Medicare knowledge possible. Please let us know if this article was helpful.
It didn't answer my question This article was helpful
We’re glad we could help you today and appreciate your feedback. When you rate our articles as most helpful, we know that we are on the right track for providing you with important news and information.
We're sorry this article didn't help you today. We'll use your feedback to review this article to try to revise or expand it. Contact us with more feedback or a question on this topic.
Last Updated: 12/27/2018