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PAP255

Maximum Daily Frequency Edits


Provider Administrative Policy

Section
Claims Submission
Policy Date
October 2009
Status/Date
New/October 2009
Provider Type(s)
All Providers  

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 only billable once per day. If Blue Cross of Idaho receives more than one unit on a procedure that has a maximum daily frequency of one, we will reduce the claim allowance to the equivalent of one unit based on the charge amount or fee schedule, whichever is less.

For example, Injection(s); single or multiple trigger point(s), one or two muscle(s) (CPT 20552) carries a maximum daily frequency of one. If it is billed with a quantity of four and total charges of $200, we will only allow $50 or the fee schedule rate, whichever is less. Our system will take the total charge amount on that line and divide it by four to apply pricing for one unit.

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

Policy History

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