Prior Auth Required

11100 - An example of an MUE would be if procedure code (i.e., biopsy of skin lesion) was billed with a quantity of two or more

This procedure appears on the selected insurer prior authorization source.

Check another codeExplore policy data
Prior authorizationPrior Auth Required
Procedure / ServiceAn example of an MUE would be if procedure code (i.e., biopsy of skin lesion) was billed with a quantity of two or more
Procedure / Service Description

MUE, or units-of-service detail edits, define the maximum units of service that a provider would report under most circumstances - was denied due to NCCI. An example of an MUE would be if procedure code 11100 (i.e., biopsy of skin lesion) was billed with a quantity of two or more. This procedure is medically unlikely to occur more than once; therefore, if it is billed with units greater than one, the detail will be denied.

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.