How do I report medically reasonable and necessary units of service in excess of a Medically Unlikely Edit (MUE) value?
Since each line of a claim is adjudicated separately against the MUE value for the code on that line, the appropriate use of Current Procedural Terminology (CPT) modifiers to report the same code on separate lines of a claim will enable a provider/supplier to report medically reasonable and necessary units of service in excess of an MUE value. CPT modifiers such as -76 (repeat procedure by same physician), -77 (repeat procedure by another physician), anatomic modifiers (e.g., RT, LT, F1, F2), -91 (repeat clinical diagnostic laboratory test), and -59 (distinct procedural service) will accomplish this purpose. Modifier – 59 should be utilized only if no other modifier describes the service. Since this approach bypasses the MUE process providers should use careful consideration before reporting multiple units of the same service for the same beneficiary on the same calendar date in excess of the MUE values. Internal compliance plans should consider appropriate protocols for any claims exc
