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Limits on units that Medicare will pay on a procedure code

  1. Default Limits on units that Medicare will pay on a procedure code
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    Can anyone help me? I am looking for the Medicare limits on units that a procedure code will pay. Example: Procedure code 22851. We have billed a 22851 and another with modifier 59. Right now Medicaid is only paying 1 per 90 days. Medicaid has incorrectly limited this procedure and I need to find out where I can find the Medicare rules so that I may inform Medicaid that they need to correct there misinformation.

    Please let me know if I have confused everyone or if someone gets what I am looking for. I have several codes that have been incorrectly limited on the units that Michigan Medicaid will pay. I am working with them to get these limits corrected.

    Thank for your help

  2. #2
    North Carolina
    Medical Billing
    You can refer them to Medicare's MUE file which lists 9 as a typical max. I haven't personally experienced any issues with submitting multiple units of 22851; although, I know Medicaid can be difficult on some issues.


    Open the 1st link under "downloads". The excel spreadsheet provides this information.

    Good Luck~
    Last edited by RebeccaWoodward*; 10-14-2010 at 07:40 AM. Reason: ADDED LINK
    Rebecca CPC, CPMA, CEMC

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