Pulmonology Coding Alert
Are You Checking Your MUEs?
Question: We billed a patient’s insurance plan for 92 units of allergy immunotherapy using code 95165, and the health plan paid for 30 units but denied the remaining 62 units saying that the benefit maximum had been reached. How do I know if the 30 units counts as the maximum per day, per month, or per year? Tennessee Subscriber Answer: Your best bet is to always check the medically unlikely edits (MUEs) for a code. In this case, 95165 (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses)) has an MUE of 30, which means only 30 units of this code can be reported on a given date of service. What that means: An MUE for a code is the maximum number of units of service (UOS) allowable by the same provider for the same beneficiary on the same date of service under most circumstances.
Pulmonology Coding Alert
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