A common billing issue we see involves the same procedure code billed on multiple lines 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. You may access this list at http://www.tricare.mil/tma/Rates.aspx.
Making sure claim lines and units are entered correctly is important for quick processing. The following are examples 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
If the claim includes three lines with one unit for each line, the additional lines appear as duplicates causing the additional lines to deny. If you have any questions or require further assistance with this matter, please call 1-877-TRICARE (1-877-874-2273).