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Billing Multiple Lines Instead of Multiple Units May Cause Payment Delays

A common billing issue we see involves the same procedure code billed on multiple lines for the same date of service instead of one line with multiple units. This can cause processing delays. We would like to help you get timely payments by clarifying this issue.

The Centers for Medicare and Medicaid Services defines a Medically Unlikely Edit (MUE) as “… the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.” TRICARE also defines maximum numbers of services per day that may be billed for specific procedure codes. View TRICARE's Rates and Reimbursement page for details. 

Making sure claim lines and units are entered correctly is important for timely and accurate reimbursement. Please review the following example for billing a pathology exam on three breast biopsy specimens:

Correct way: One line with CPT® 88305 and 3 units

Wrong way: Three lines with CPT® 88305 with 1 unit each for the same date of service (additional lines appear as duplicates which will cause them to deny)