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CPT 95165

Carlos Posted Fri 21st of June, 2019 10:55:06 AM
We billed Avmed Health Plan 92 units for CPT 95165, Health Plan paid for 30 units and rest 62 units denied as Benefit maximum for this time period or occurrence has been reached. Can you please find out for me if 30 is the maximum units allowed per day? per month or per year? I already know Medicare pays for 10 units a day and we can bill consecutive days until we reach the total units.
SuperCoder Answered Mon 24th of June, 2019 04:14:33 AM

Hi Carlos,


Thanks for your question.


CPT 95165 has MUE of 30 which means only 30 units of this code can be reported on a given date of service.


An MUE for a HCPCS/CPT code is the maximum number of units of service (UOS) under most circumstances allowable by the same provider for the same beneficiary on the same date of service.  The ideal MUE value for a HCPCS/CPT code is the unit of service that allows the vast majority of appropriately coded claims to pass the MUE.


This means you may report only 30 units of this code on a single day.


Hope this helps.


Please feel free to write if you have any question.



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