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Allowed units

Apurva Posted Wed 29th of January, 2020 00:16:12 AM
Can you please let us know how many units of 87798 can be billed per day for WPS MAC (Wisconsin physician service).
SuperCoder Answered Thu 30th of January, 2020 05:58:34 AM

Hello Apurva,

Thank you for your question.

 

As per CMS MUE Guidelines, the maximum allowable units per day for CPT® code 87798 is 13, that indicates, it is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.

 

Also, this test may be performed multiple times for different organisms. In this case, 87798 can be reported for the initial organism and 87798-59 for the additional organisms. However, if one test is performed and 3 results are obtained for a single organism, only one unit may be reported for the single test.

 

Note: CMS releases the Medically Unlikely Edits (MUE) data and in general, all the Medicare Administrative Contractor (MAC) follow the MUE data released by the CMS.

 

Hope that helps!

Thanks

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