For incorrectly denied or underpaid Original bills, DaisyBill advises filing a Second Review and including IBR decisions as supporting documentation.

Official Medical Fee Schedule

Physician Services

CPT Code(s)

Physical Medicine / Chiropractic / Acupuncture Multiple Procedure Payment Reduction; Pre-Authorization for Specified Procedure / Modality Services

Payable

Yes

EOR Denial Reason

Maximum units exceeded.

Second Review Reason (SBR-1)

Recommended Reason

MUE incorrectly cited as reason for $0 reimbursement. § 9789.12.13  Correct Coding Initiative.

(c) Medically Unlikely Edits are published by CMS on its website at: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html document “Practitioner Services MUE Table.” See section 9789.19 for the adopted version of the Practitioner Services MUE Table, by date of service.

DaisyBill Resources

Webinar: Request for Second Review

Webinar: Second Review Strategy Kit, Part I

Webinar: Second Review Strategy Kit, Part II

DaisyBill Solution

Every request for Second Review submitted from DaisyBill is compliantly submitted using both a completed DWC Form SBR-1, as well as a compliant modified CMS 1500.