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units per cpt can you bill??

Pamela Posted Tue 29th of January, 2013 01:00:11 AM

I don't normally do lab billing. This doc wants to know per cpt of drug tests performed, ex: 82055 how many units can you billfor that code? He has sent me a whole list to do and I have been searching the internet and am lost. Would greatly appreciate help.

SuperCoder Answered Wed 30th of January, 2013 21:49:20 PM

My editor would be answering you in this regard soon. Not just for 82055 but for that far whole list.


SuperCoder Answered Thu 31st of January, 2013 08:51:26 AM

MUE (Medicare Unlikely Edits) published by CMS dictates the maximum no. of units that a CPT/HCPCS codes can be billed for each day. This data is basically for payers to use/refer, as CMS suggests.

CPT 82055 has a MUE value of 2, which means that this code can be billed 2 units maximum per day.

SuperCoder's FEE SCHEDULE section covers MUE information for CPT/HCPCS codes.

Pamela Posted Thu 31st of January, 2013 15:31:32 PM

Can you please tell me where on medicare I find this list? He has questions for about 10 cpts. I went to medicare and saw fee schdule, but not listed there. Your help is much appreciated.

Pamela Posted Thu 31st of January, 2013 19:02:47 PM

Got the answer, but still need 2 codes not on medicare's mues. Can you help me with 82542 and 82491, or guide me to a resource? Thank you for the help.

SuperCoder Answered Fri 01st of February, 2013 07:17:06 AM

CMS does not provide MUE valu for all CPT/HCPCS codes. Both of the codes mentioned by you do not have any designated MUE value provided by CMS.

SuperCoder provides all MUE values along with fee schedule details for each code, provided a value assigned to the code by CMS, through multiple fee schedules. You can check the MUE and other values in SuperCoder.

In CMS site, MUE value is provided within NCCI data section. Go to CMS site > Medicare > NCCI, and then see MUE tab at left side pane of the page.

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