The medically unlikely edits (MUE) do limit 3 units of acupuncture 1 initial set and up to 2 subsequent sets. However, Empire BCBS (New York) is taking a step further and denying any additional sets. It is worth an appeal to note specifically the edits indicate 3, not 1 set only. I am also recommending to add modifier 59 to the second or subsequent sets of acupuncture to demonstrate the distinct and separate nature of the subsequent sets. The use of this modifier may allow a bypass of the edit and allow the proper reimbursement of at least 2 sets in addition to he primary or initial set.

 

Categories: Uncategorized

Leave a Reply