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Ask a Rev Cycle Expert: MUE Question for CPT® Code 86255?


If a Current Procedural Terminology CPT® code has a Medically Unlikely Edit (MUE) of 5 but the test requires 9, can modifier 59 Distinct Procedural Service be added? For example, CPT® 86255 Fluorescent noninfectious agent antibody; screen, each antibody.


Unfortunately, modifier 59 Distinct Procedural Service does not override an MUE edit. You will need to review the MUE Adjudication Indicator (MAI) for the code. CPT® 86255 has an MAI of 3 Date of Service Edit: Clinical. For services with the MAI of 3, the claim line item will need to be denied, then you may appeal the denial with your Medicare Administrative Contractor (MAC).

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