Effective July 1, 2017, Harvard Pilgrim will begin utilizing the Centers for Medicare and Medicaid Services’ (CMS’s) maximum unit values — or medically unlikely edits (MUE) — for CPT and HCPCS codes, where available. Harvard Pilgrim will continue to apply its own existing maximum frequency per day values for those CPT or HCPCS codes that do not have an associated MUE value from CMS.
With this update, Harvard Pilgrim will not provide additional reimbursement for codes for which the MUE value has been exceeded. As a reminder, when submitting a claim, it is important to submit the total number of units on one line, rather than individual claim lines; billing the same procedure code on multiple individual claim lines may result in the claim being denied as a duplicate. For more information, please refer to Harvard Pilgrim’s updated Maximum Units Per Day Payment Policy.