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Click here for more sample CPC practice exam questions and answers with full rationale

Reimbursement issue regarding 26145 and exceeding the MEU of 6 by 3 units

Hello,

Reimbursement issue regarding 26145 and exceeding the MEU of 6 by 3 units.

Scenario:

Provider bills 26145 x 9, exceeding the MUEs by 3 and states in the Op report that a "copious amount of hypertrophic tenosynovium was noted on the nine flexor tendons in the palm and a careful and sharp tenosynovectmoy of the nine tendons in the palm was then performed," would this statement satisfy MAI 3 requirement?

If so, why?

if not, why not?

if I could get a link to support either decision, this would be extremely helpful.

Thank you!

Medical Billing and Coding Forum

Charging Medicaid Pts for Chiro visits exceeding the coverage limit?

In California, there is a twice monthly limit on covered benefits for Chiro. If a Medi-Cal (Medicaid) Pt wants additional visits of the sort, are we allowed to chage them? I know that we can charge for uncovered benefits and we frequently do, in dental, particularly. But these are covered ‘optional benefits’ in excess of the limits.
Thanks!:D

Medical Billing and Coding Forum