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Wiki XU Modifier for Medically Unlikely Edit?

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sarowe

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CPT code 14302 has MUE Indicator 3, with maximum allowable units of 8 for a given date of service. Is it appropriate to use -XU modifier in a case where we appropriately coded for additional units? My understanding based on CGS explanation of the MAIs is that a modifier would not be used for a CPT code with an MAI other than 1.

From CGS (link below):
MUE Adjudication Indicator (MAI)

The MAI provides the rationale for the edit.

  • MAI 1: Claim Line Edit.
    • You may add a modifier to bill the same code on separate lines of a claim to identify additional medically necessary units over the MUE value.
  • MAI 2: Absolute Date of Service Edit.
    • These are "per day" edits based on policy. CGS will not pay in excess of the MUE value.
  • MAI 3: Date of Service Edit.
    • These are "per day" edits based on clinical benchmarks. CGS may pay over the MUE value at the appeals (Redetermination) level if there is adequate documentation of medical necessity to support additional units.
 
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