Has your practice seen denial of the following code for units of service exceeding a payer’s allowed number of services per day?

If so, you are not alone.

Current Procedural Terminology (CPT®) instructs that one unit of code 90461 is reported for each additional component (after the first component reported with code 90460) of a multiple-component vaccine or toxoid and includes no limitation on the number of additional components that may be reported. However, in recent versions of the Medically Unlikely Edits (MUEs) developed for the Medicare program, code 90461 was added to the list of codes for which the number of units provided on a single date is limited. The maximum number of units allowable per day for code 90461 is 5 units per the MUE. Many private payers use Medicare MUEs as a basis for their claim edits (eg, maximum frequency per day [MFD] edits)...

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