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Maximum Daily Frequency Edits


Provider Administrative Policy

Section
Provider Information
Policy Date
October 2009
Status/Date
Revised/January 2012

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Maximum Daily Frequency Edits

Certain procedures are billable only once per day.

If Blue Cross of Idaho receives a claim with units exceeding the maximum daily frequency, we will reduce the claim allowance to an equivalent of one unit based on the charge amount.

Our Clinical Editing Tool can be used to determine which CPT/HCPCS codes have daily frequency limitations.

You can also find the list of CMS Medically Unlikely Edit at:
http://www.cms.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage


Policy History

Date Action Reason
January 2012 Revised Add link to CMS Medically Unlikely Edit
January 2010 Revised Language updated

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