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MUE vs MAI

Teresa Posted Mon 29th of June, 2020 12:58:13 PM
Has anyone ever billed 13132 with RT and LT? I know it only carries 1 MUE but the MAI has category 2. Also, 49650 will pay with RT, LT and it also carries only 1 MUE, also MAI 2 and it paid. A little confused when it comes to MAI, any help is appreciated. Teresa
SuperCoder Answered Tue 30th of June, 2020 09:40:08 AM

Hi Teresa,

Each MUE has a “Medicare Adjudication Indicator” (MAI). This indicates whether the MUE is a line edit or a date of service edit. If it is a line edit, the MUE will be applied on a line basis. This may allow billing in excess of the MUE by using more than one line of the claim form. The date of service edits apply to all services provided on a given date. For CPT 13132 and 49650. the MUE is 1 and MAI is 2, and MAI 2 is Date of Service Edit, which means it is an absolute date of service (DOS) edit based on policy. Payers who apply the MUE sum the code's same-DOS units (not counting lines with modifier 55). If the sum exceeds the MUE value, the payer will deny same-DOS lines with that code on the current claim. CMS has not identified any instances in which exceeding a MAI 2 MUE is correct.

Also, for CPT 13132 there is No 150% bilateral payment boost is applicable, so you cannot append modifier 50 or RT and LT, however, RT or LT (any one) can be appended with CPT 13132 just to show the laterality; right or left as an informational modifier. Whereas, in CPT 49650, 150% bilateral adjustment applies, so you can append the modifier 50 or RT and LT, it will get paid as per guidelines and medical necessity.

Hope this helps!

Teresa Posted Tue 30th of June, 2020 10:09:56 AM
Thanks for the help, it now makes more sense to me.Teresa
SuperCoder Answered Wed 01st of July, 2020 00:35:51 AM

Thank you, happy to help.

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