A9587 help please

[cknorr]

a9587 patient was given 6.33 mCi. should we bill for 64 units or 54 because 54 is the mue? I asked chat and this was the answer below. So what is the correct way to bill for this?
For A9587 with an administered dose of 6.33 mCi, the key point is that you should not reduce the billed quantity to 54 just because 54 is the MUE, nor bill 64 simply to reach a limit. The units must reflect the actual dose under the HCPCS descriptor and the payer's rules.

• If A9587 is billed per 0.1 mCi, 6.33 mCi calculates to 63.3 units, which generally rounds to 64 units.
• If the payer's MUE is 54, billing 64 may trigger an edit and require supporting documentation or an appeal.
• Do not automatically cap the claim at 54 if that would misrepresent the administered quantity.

The current MUE for A9587 is 54 units, based on the 5.4 mCi maximum dose in the prescribing information. The edit is a clinical edit, so Medicare may consider payment above 54 units through an appeal with adequate documentation.


Important: 6.33 mCi exceeds the labeled 5.4 mCi maximum.