New Reimbursement Policy Addresses Maximum Allowable Units per Day for CPT and HCPCS Codes

UnitedHealthcare Medicare Advantage will implement the new Maximum Frequency per Day Policy to address maximum allowable units per day for CPT and Healthcare Common Procedure Coding System (HCPCS) codes where the CMS has not published a National Correct Coding Initiative (NCCI) Medically Unlikely Edit (MUE) or units value. For codes with a CMS MUE, the new Maximum Frequency per Day Policy will not apply. Effective with dates of service on and after Sept. 1, 2016, UnitedHealthcare will reimburse units for services not addressed by a CMS MUE value according to the Maximum Frequency per Day policy.

Source: https://www.unitedhealthcareonline.com/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticFiles/ProviderStaticFilesPdf/News/June_2016_Network_Bulletin_PCA-1-001852-05062016_.pdf#page=3