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Wiki 78452/Maximum coverage amount met or exceeded for benefit period

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nancytacoaman

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Question please -Medicaid is denying claim bc Maximum coverage amount met or exceeded for benefit period. There was 2 units approved in the P/A one was already used. Do we need to add TC on the claim?

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The Medicaid MUE listed in Codify for 78452 is 1. Are you billing for 2 units on the same date of service? If so, you're likely going to have to appeal with your Medicaid contractor to explain why 2 were billed and see if they will override the MUE denial.
 
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