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Wiki BCBS denials for 95165 for MUE's

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shavird@onyxsc.org

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Hi, we have been receiving denials from BCBS starting around the middle of November due to exceeding limits. Last year we had to change the way we bill to 30 units/day for a rolling 365-day year. So now we will bill a new start with 30 units/day on succeeding days for the first 100 units which will usually get us to the maintenance dose. Now they are saying that we can only bill 30 units every 3 days due to cms.gov. I've reviewed the MUE spreadsheet for cms.gov and it does appear that they are changing to 30 units every 3 days but not until 1/1/24. Can someone advise what I might be missing. We can't seem to get definitive answers from BCBS.

Thanks!
 
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