Medicare Code Units Limit
medicare_code_units_limitHow many units of a procedure code will Medicare pay for one patient in one day? Returns the NCCI Medically Unlikely Edit (MUE) — the maximum units allowed — with the adjudication indicator saying whether the limit is absolute or can be overridden with documentation, and the rationale for it. Answers "what is the MUE for 99213", "how many units of this code can I bill", "why was my claim denied for units". Available for practitioner, outpatient hospital and DME settings, which have different limits for the same code. States the quarterly edit vintage in force. Sourced from the CMS National Correct Coding Initiative.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| code | Yes | HCPCS/CPT code, e.g. "99213". | |
| setting | No | Which MUE table: "practitioner" (default), "outpatient_hospital", or "dme". The same code can carry different limits in each. |