Revision to Maximum Frequency per Day for Codes Assigned MAI of “2”

Effective first quarter 2016, the Maximum Frequency per Day (MFD) Policy will be revised to align with the CMS Medically

Unlikely Edit (MUE) adjudication indicator (MAI) for procedure codes assigned a MAI of “2”. This indicator is used by CMS to identify CPT or HCPCS codes where units of service on the same date of service in excess of the MUE value would be considered

contrary to code description or instruction, statute, regulation or sub-regulatory guidance. Units in excess of the MFD value will not be reimbursed for CPT/HCPCS codes assigned an MAI of “2”. Consistent with CMS guidelines, no modifier override will be allowed nor will the MFD value be overridden by submitting documentation for adjustment requests.

Source: https://www.unitedhealthcareonline.com