facility outpatient services edits - coding updatesfacility outpatient services edits (effective...
TRANSCRIPT
1
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
2014 Hospital Outpatient Services Medically Unlikely Edits (MUE)
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
A0382 0 3 Date of Service Edit: Clinical
A0384 0 3 Date of Service Edit: Clinical
A0392 0 3 Date of Service Edit: Clinical
A0394 0 3 Date of Service Edit: Clinical
A0396 0 3 Date of Service Edit: Clinical
A0398 0 3 Date of Service Edit: Clinical
A0420 0 3 Date of Service Edit: Clinical
A0422 0 3 Date of Service Edit: Clinical
A0424 0 3 Date of Service Edit: Clinical
A0426 2 3 Date of Service Edit: Clinical
A0427 2 3 Date of Service Edit: Clinical
A0428 4 3 Date of Service Edit: Clinical
A0429 2 3 Date of Service Edit: Clinical
A0430 1 3 Date of Service Edit: Clinical
A0431 1 3 Date of Service Edit: Clinical
A0432 1 3 Date of Service Edit: Clinical
A0433 1 3 Date of Service Edit: Clinical
A0434 2 3 Date of Service Edit: Clinical
A0435 999 3 Date of Service Edit: Clinical
A0436 300 3 Date of Service Edit: Clinical
A4221 0 3 Date of Service Edit: Clinical
A4222 0 3 Date of Service Edit: Clinical
A4233 0 3 Date of Service Edit: Clinical
A4234 0 3 Date of Service Edit: Clinical
A4235 0 3 Date of Service Edit: Clinical
A4236 0 3 Date of Service Edit: Clinical
A4253 0 3 Date of Service Edit: Clinical
A4255 0 3 Date of Service Edit: Clinical
A4256 0 3 Date of Service Edit: Clinical
A4257 0 3 Date of Service Edit: Clinical
A4258 0 3 Date of Service Edit: Clinical
A4259 0 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
A4262 4 2 Date of Service Edit: Policy
A4263 4 2 Date of Service Edit: Policy
A4301 1 2 Date of Service Edit: Policy
A4356 1 1 Line Edit
A4396 3 1 Line Edit
A4399 2 1 Line Edit
A4463 3 1 Line Edit
A4470 1 1 Line Edit
A4480 1 1 Line Edit
A4555 0 3 Date of Service Edit: Clinical
A4557 0 3 Date of Service Edit: Clinical
A4561 1 1 Line Edit
A4562 1 1 Line Edit
A4565 2 3 Date of Service Edit: Clinical
A4595 0 3 Date of Service Edit: Clinical
A4604 0 3 Date of Service Edit: Clinical
A4605 0 3 Date of Service Edit: Clinical
A4606 1 3 Date of Service Edit: Clinical
A4611 0 3 Date of Service Edit: Clinical
A4612 0 3 Date of Service Edit: Clinical
A4613 0 3 Date of Service Edit: Clinical
A4614 0 3 Date of Service Edit: Clinical
A4618 0 3 Date of Service Edit: Clinical
A4623 90 3 Date of Service Edit: Clinical
A4624 0 3 Date of Service Edit: Clinical
A4625 30 3 Date of Service Edit: Clinical
A4628 0 3 Date of Service Edit: Clinical
A4633 0 3 Date of Service Edit: Clinical
A4635 0 3 Date of Service Edit: Clinical
A4636 0 3 Date of Service Edit: Clinical
A4637 0 3 Date of Service Edit: Clinical
A4638 0 3 Date of Service Edit: Clinical
Facility Outpatient Services Edits(Effective Date: 10/01/2014-12/31/2014, Version: 20.3)
This fi le contains two sets of edits that provide guidance when reporting HCPCS codes within the Hospital Outpatient Prospective Payment System (PPS).
1. Practitioner/DME Supplier Medically Unlikely Edits (MUE) units indicate the maximum allowable number of units of service per day, per patient. The third fi eld indicates whether each MUE is a claim line or date of service edit. The purpose of the MUEs project is to detect and deny unlikely Medicare claims on a pre-payment basis in order to stop inappropriate payment. The MUE project is not meant to establish Medicare payment policy, but rather to improve the accuracy of the Medicare payments.
2. Columns 1 and 2 Correct Coding Edits are National Correct Coding Initiative (NCCI) edits for physicians and list codes that are not reported together.
2
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
A4640 0 3 Date of Service Edit: Clinical
A4642 1 1 Line Edit
A4648 3 3 Date of Service Edit: Clinical
A4650 3 1 Line Edit
A4670 0 3 Date of Service Edit: Clinical
A4932 0 3 Date of Service Edit: Clinical
A5056 90 3 Date of Service Edit: Clinical
A5057 90 3 Date of Service Edit: Clinical
A5102 1 1 Line Edit
A5120 150 3 Date of Service Edit: Clinical
A5500 0 3 Date of Service Edit: Clinical
A5501 0 3 Date of Service Edit: Clinical
A5503 0 3 Date of Service Edit: Clinical
A5504 0 3 Date of Service Edit: Clinical
A5505 0 3 Date of Service Edit: Clinical
A5506 0 3 Date of Service Edit: Clinical
A5507 0 3 Date of Service Edit: Clinical
A5508 0 3 Date of Service Edit: Clinical
A5510 0 3 Date of Service Edit: Clinical
A5512 0 3 Date of Service Edit: Clinical
A5513 0 3 Date of Service Edit: Clinical
A6501 2 1 Line Edit
A6502 2 1 Line Edit
A6503 2 1 Line Edit
A6504 4 1 Line Edit
A6505 4 1 Line Edit
A6506 4 1 Line Edit
A6507 4 1 Line Edit
A6508 4 1 Line Edit
A6509 2 1 Line Edit
A6510 2 1 Line Edit
A6511 2 1 Line Edit
A6513 2 1 Line Edit
A6545 2 1 Line Edit
A6550 0 3 Date of Service Edit: Clinical
A7000 0 3 Date of Service Edit: Clinical
A7001 0 3 Date of Service Edit: Clinical
A7002 0 3 Date of Service Edit: Clinical
A7003 0 3 Date of Service Edit: Clinical
A7004 0 3 Date of Service Edit: Clinical
A7005 0 3 Date of Service Edit: Clinical
A7006 0 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
A7007 0 3 Date of Service Edit: Clinical
A7010 0 3 Date of Service Edit: Clinical
A7012 0 3 Date of Service Edit: Clinical
A7013 0 3 Date of Service Edit: Clinical
A7014 0 3 Date of Service Edit: Clinical
A7015 0 3 Date of Service Edit: Clinical
A7016 0 3 Date of Service Edit: Clinical
A7017 0 3 Date of Service Edit: Clinical
A7018 0 3 Date of Service Edit: Clinical
A7020 0 3 Date of Service Edit: Clinical
A7025 0 3 Date of Service Edit: Clinical
A7026 0 3 Date of Service Edit: Clinical
A7027 0 3 Date of Service Edit: Clinical
A7028 0 3 Date of Service Edit: Clinical
A7029 0 3 Date of Service Edit: Clinical
A7030 0 3 Date of Service Edit: Clinical
A7031 0 3 Date of Service Edit: Clinical
A7032 0 3 Date of Service Edit: Clinical
A7033 0 3 Date of Service Edit: Clinical
A7034 0 3 Date of Service Edit: Clinical
A7035 0 3 Date of Service Edit: Clinical
A7036 0 3 Date of Service Edit: Clinical
A7037 0 3 Date of Service Edit: Clinical
A7038 0 3 Date of Service Edit: Clinical
A7039 0 3 Date of Service Edit: Clinical
A7040 2 1 Line Edit
A7041 2 1 Line Edit
A7042 2 1 Line Edit
A7043 10 3 Date of Service Edit: Clinical
A7044 0 3 Date of Service Edit: Clinical
A7045 0 3 Date of Service Edit: Clinical
A7046 0 3 Date of Service Edit: Clinical
A7047 0 3 Date of Service Edit: Clinical
A7502 3 1 Line Edit
A7503 3 1 Line Edit
A7504 180 3 Date of Service Edit: Clinical
A7506 90 3 Date of Service Edit: Clinical
A7507 200 3 Date of Service Edit: Clinical
A7508 200 3 Date of Service Edit: Clinical
A7509 300 3 Date of Service Edit: Clinical
A7522 1 2 Date of Service Edit: Policy
A7524 2 1 Line Edit
3
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
A7526 36 3 Date of Service Edit: Clinical
A9272 0 1 Line Edit
A9284 1 1 Line Edit
A9500 3 1 Line Edit
A9501 3 1 Line Edit
A9502 3 1 Line Edit
A9503 1 1 Line Edit
A9504 1 1 Line Edit
A9507 1 1 Line Edit
A9508 2 3 Date of Service Edit: Clinical
A9510 1 1 Line Edit
A9512 30 3 Date of Service Edit: Clinical
A9520 1 3 Date of Service Edit: Clinical
A9521 2 1 Line Edit
A9526 2 1 Line Edit
A9536 1 1 Line Edit
A9537 1 1 Line Edit
A9538 1 1 Line Edit
A9539 2 1 Line Edit
A9540 2 1 Line Edit
A9541 1 1 Line Edit
A9542 1 1 Line Edit
A9543 1 1 Line Edit
A9544 1 1 Line Edit
A9545 1 1 Line Edit
A9546 1 1 Line Edit
A9547 2 3 Date of Service Edit: Clinical
A9550 1 1 Line Edit
A9551 1 1 Line Edit
A9552 1 1 Line Edit
A9553 1 1 Line Edit
A9554 1 1 Line Edit
A9555 3 1 Line Edit
A9556 10 3 Date of Service Edit: Clinical
A9557 2 1 Line Edit
A9559 1 1 Line Edit
A9560 2 1 Line Edit
A9561 1 1 Line Edit
A9562 2 1 Line Edit
A9566 1 1 Line Edit
A9567 2 1 Line Edit
A9569 1 1 Line Edit
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
A9570 1 1 Line Edit
A9571 1 1 Line Edit
A9579 100 3 Date of Service Edit: Clinical
A9580 1 1 Line Edit
A9582 1 3 Date of Service Edit: Clinical
A9583 18 3 Date of Service Edit: Clinical
A9584 1 1 Line Edit
A9585 300 3 Date of Service Edit: Clinical
A9586 1 1 Line Edit
A9599 1 3 Date of Service Edit: Clinical
A9600 7 3 Date of Service Edit: Clinical
A9604 1 3 Date of Service Edit: Clinical
A9700 2 1 Line Edit
B4034 0 3 Date of Service Edit: Clinical
B4035 0 3 Date of Service Edit: Clinical
B4036 0 3 Date of Service Edit: Clinical
B4081 0 3 Date of Service Edit: Clinical
B4082 0 3 Date of Service Edit: Clinical
B4083 0 3 Date of Service Edit: Clinical
B4087 1 1 Line Edit
B4149 0 3 Date of Service Edit: Clinical
B4150 0 3 Date of Service Edit: Clinical
B4152 0 3 Date of Service Edit: Clinical
B4153 0 3 Date of Service Edit: Clinical
B4154 0 3 Date of Service Edit: Clinical
B4155 0 3 Date of Service Edit: Clinical
B4157 0 3 Date of Service Edit: Clinical
B4158 0 3 Date of Service Edit: Clinical
B4159 0 3 Date of Service Edit: Clinical
B4160 0 3 Date of Service Edit: Clinical
B4161 0 3 Date of Service Edit: Clinical
B4162 0 3 Date of Service Edit: Clinical
B4164 0 3 Date of Service Edit: Clinical
B4168 0 3 Date of Service Edit: Clinical
B4172 0 3 Date of Service Edit: Clinical
B4176 0 3 Date of Service Edit: Clinical
B4178 0 3 Date of Service Edit: Clinical
B4180 0 3 Date of Service Edit: Clinical
B4189 0 3 Date of Service Edit: Clinical
B4193 0 3 Date of Service Edit: Clinical
B4197 0 3 Date of Service Edit: Clinical
B4199 0 3 Date of Service Edit: Clinical
4
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
B4216 0 3 Date of Service Edit: Clinical
B4220 0 3 Date of Service Edit: Clinical
B4222 0 3 Date of Service Edit: Clinical
B4224 0 3 Date of Service Edit: Clinical
B5000 0 3 Date of Service Edit: Clinical
B5100 0 3 Date of Service Edit: Clinical
B5200 0 3 Date of Service Edit: Clinical
B9000 0 3 Date of Service Edit: Clinical
B9002 0 3 Date of Service Edit: Clinical
B9004 0 3 Date of Service Edit: Clinical
B9006 0 3 Date of Service Edit: Clinical
C1721 1 3 Date of Service Edit: Clinical
C1722 1 3 Date of Service Edit: Clinical
C1731 2 1 Line Edit
C1732 3 1 Line Edit
C1733 3 1 Line Edit
C1749 1 3 Date of Service Edit: Clinical
C1750 2 1 Line Edit
C1751 3 1 Line Edit
C1752 2 1 Line Edit
C1753 2 1 Line Edit
C1754 2 1 Line Edit
C1755 2 1 Line Edit
C1756 2 1 Line Edit
C1758 2 1 Line Edit
C1759 2 1 Line Edit
C1764 1 3 Date of Service Edit: Clinical
C1767 2 1 Line Edit
C1768 3 1 Line Edit
C1770 3 1 Line Edit
C1771 1 3 Date of Service Edit: Clinical
C1772 1 3 Date of Service Edit: Clinical
C1773 3 1 Line Edit
C1777 2 1 Line Edit
C1779 2 1 Line Edit
C1780 2 1 Line Edit
C1782 1 3 Date of Service Edit: Clinical
C1783 2 1 Line Edit
C1784 2 1 Line Edit
C1785 1 3 Date of Service Edit: Clinical
C1786 1 3 Date of Service Edit: Clinical
C1787 2 1 Line Edit
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
C1788 2 1 Line Edit
C1789 2 1 Line Edit
C1813 1 3 Date of Service Edit: Clinical
C1814 2 1 Line Edit
C1815 1 3 Date of Service Edit: Clinical
C1816 2 1 Line Edit
C1817 1 3 Date of Service Edit: Clinical
C1818 2 1 Line Edit
C1820 2 1 Line Edit
C1830 2 1 Line Edit
C1840 1 3 Date of Service Edit: Clinical
C1841 1 3 Date of Service Edit: Clinical
C1878 2 1 Line Edit
C1880 2 1 Line Edit
C1881 2 1 Line Edit
C1882 1 3 Date of Service Edit: Clinical
C1886 1 3 Date of Service Edit: Clinical
C1888 2 1 Line Edit
C1891 1 1 Line Edit
C1895 2 1 Line Edit
C1896 2 1 Line Edit
C1897 2 1 Line Edit
C1898 2 1 Line Edit
C1899 2 1 Line Edit
C1900 1 3 Date of Service Edit: Clinical
C2614 3 1 Line Edit
C2615 2 1 Line Edit
C2616 1 3 Date of Service Edit: Clinical
C2619 1 3 Date of Service Edit: Clinical
C2620 1 3 Date of Service Edit: Clinical
C2621 1 3 Date of Service Edit: Clinical
C2622 1 3 Date of Service Edit: Clinical
C2626 1 3 Date of Service Edit: Clinical
C2627 2 1 Line Edit
C2631 1 3 Date of Service Edit: Clinical
C5271 1 2 Date of Service Edit: Policy
C5272 3 2 Date of Service Edit: Policy
C5273 1 2 Date of Service Edit: Policy
C5274 35 3 Date of Service Edit: Clinical
C5275 1 2 Date of Service Edit: Policy
C5276 3 2 Date of Service Edit: Policy
C5277 1 2 Date of Service Edit: Policy
5
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
C5278 15 3 Date of Service Edit: Clinical
C8900 1 3 Date of Service Edit: Clinical
C8901 1 3 Date of Service Edit: Clinical
C8902 1 3 Date of Service Edit: Clinical
C8903 1 3 Date of Service Edit: Clinical
C8904 1 3 Date of Service Edit: Clinical
C8905 1 3 Date of Service Edit: Clinical
C8906 1 3 Date of Service Edit: Clinical
C8907 1 3 Date of Service Edit: Clinical
C8908 1 3 Date of Service Edit: Clinical
C8909 1 3 Date of Service Edit: Clinical
C8910 1 3 Date of Service Edit: Clinical
C8911 1 3 Date of Service Edit: Clinical
C8912 1 3 Date of Service Edit: Clinical
C8913 1 3 Date of Service Edit: Clinical
C8914 1 3 Date of Service Edit: Clinical
C8918 1 3 Date of Service Edit: Clinical
C8919 1 3 Date of Service Edit: Clinical
C8920 1 3 Date of Service Edit: Clinical
C8921 1 3 Date of Service Edit: Clinical
C8922 1 3 Date of Service Edit: Clinical
C8923 1 3 Date of Service Edit: Clinical
C8924 1 3 Date of Service Edit: Clinical
C8925 1 3 Date of Service Edit: Clinical
C8926 1 3 Date of Service Edit: Clinical
C8927 1 3 Date of Service Edit: Clinical
C8928 1 2 Date of Service Edit: Policy
C8929 1 3 Date of Service Edit: Clinical
C8930 1 2 Date of Service Edit: Policy
C8931 1 3 Date of Service Edit: Clinical
C8932 1 3 Date of Service Edit: Clinical
C8933 1 3 Date of Service Edit: Clinical
C8934 2 1 Line Edit
C8935 2 1 Line Edit
C8936 2 1 Line Edit
C8957 2 3 Date of Service Edit: Clinical
C9254 400 3 Date of Service Edit: Clinical
C9275 1 3 Date of Service Edit: Clinical
C9285 2 3 Date of Service Edit: Clinical
C9290 266 3 Date of Service Edit: Clinical
C9293 700 3 Date of Service Edit: Clinical
C9352 3 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
C9353 4 3 Date of Service Edit: Clinical
C9354 300 3 Date of Service Edit: Clinical
C9355 3 3 Date of Service Edit: Clinical
C9356 125 3 Date of Service Edit: Clinical
C9358 800 3 Date of Service Edit: Clinical
C9359 30 3 Date of Service Edit: Clinical
C9360 300 3 Date of Service Edit: Clinical
C9361 10 3 Date of Service Edit: Clinical
C9362 60 3 Date of Service Edit: Clinical
C9363 500 3 Date of Service Edit: Clinical
C9364 600 3 Date of Service Edit: Clinical
C9600 3 3 Date of Service Edit: Clinical
C9601 2 1 Line Edit
C9602 3 3 Date of Service Edit: Clinical
C9603 2 1 Line Edit
C9604 3 1 Line Edit
C9605 3 1 Line Edit
C9606 2 3 Date of Service Edit: Clinical
C9607 1 2 Date of Service Edit: Policy
C9608 2 3 Date of Service Edit: Clinical
C9724 1 2 Date of Service Edit: Policy
C9725 1 3 Date of Service Edit: Clinical
C9726 2 1 Line Edit
C9727 1 2 Date of Service Edit: Policy
C9728 1 2 Date of Service Edit: Policy
C9733 1 1 Line Edit
C9734 1 3 Date of Service Edit: Clinical
C9735 1 2 Date of Service Edit: Policy
C9737 1 2 Date of Service Edit: Policy
C9739 1 2 Date of Service Edit: Policy
C9740 1 2 Date of Service Edit: Policy
C9800 1 1 Line Edit
C9898 1 3 Date of Service Edit: Clinical
E0100 0 3 Date of Service Edit: Clinical
E0105 0 3 Date of Service Edit: Clinical
E0110 0 3 Date of Service Edit: Clinical
E0111 0 3 Date of Service Edit: Clinical
E0112 0 3 Date of Service Edit: Clinical
E0113 0 3 Date of Service Edit: Clinical
E0114 0 3 Date of Service Edit: Clinical
E0116 0 3 Date of Service Edit: Clinical
E0117 0 3 Date of Service Edit: Clinical
6
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E0118 0 3 Date of Service Edit: Clinical
E0130 0 3 Date of Service Edit: Clinical
E0135 0 3 Date of Service Edit: Clinical
E0140 0 3 Date of Service Edit: Clinical
E0141 0 3 Date of Service Edit: Clinical
E0143 0 3 Date of Service Edit: Clinical
E0144 0 3 Date of Service Edit: Clinical
E0147 0 3 Date of Service Edit: Clinical
E0148 0 3 Date of Service Edit: Clinical
E0149 0 3 Date of Service Edit: Clinical
E0153 0 3 Date of Service Edit: Clinical
E0154 0 3 Date of Service Edit: Clinical
E0155 0 3 Date of Service Edit: Clinical
E0156 0 3 Date of Service Edit: Clinical
E0157 0 3 Date of Service Edit: Clinical
E0158 0 3 Date of Service Edit: Clinical
E0159 0 3 Date of Service Edit: Clinical
E0160 0 3 Date of Service Edit: Clinical
E0161 0 3 Date of Service Edit: Clinical
E0162 0 3 Date of Service Edit: Clinical
E0163 0 3 Date of Service Edit: Clinical
E0165 0 3 Date of Service Edit: Clinical
E0167 0 3 Date of Service Edit: Clinical
E0168 0 3 Date of Service Edit: Clinical
E0170 0 3 Date of Service Edit: Clinical
E0171 0 3 Date of Service Edit: Clinical
E0172 0 3 Date of Service Edit: Clinical
E0175 0 3 Date of Service Edit: Clinical
E0181 0 3 Date of Service Edit: Clinical
E0182 0 3 Date of Service Edit: Clinical
E0184 0 3 Date of Service Edit: Clinical
E0185 0 3 Date of Service Edit: Clinical
E0186 0 3 Date of Service Edit: Clinical
E0187 0 3 Date of Service Edit: Clinical
E0188 0 3 Date of Service Edit: Clinical
E0189 0 3 Date of Service Edit: Clinical
E0190 0 3 Date of Service Edit: Clinical
E0191 0 3 Date of Service Edit: Clinical
E0193 0 3 Date of Service Edit: Clinical
E0194 0 3 Date of Service Edit: Clinical
E0196 0 3 Date of Service Edit: Clinical
E0197 0 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E0198 0 3 Date of Service Edit: Clinical
E0199 0 3 Date of Service Edit: Clinical
E0200 0 3 Date of Service Edit: Clinical
E0202 0 3 Date of Service Edit: Clinical
E0203 0 3 Date of Service Edit: Clinical
E0205 0 3 Date of Service Edit: Clinical
E0210 0 3 Date of Service Edit: Clinical
E0215 0 3 Date of Service Edit: Clinical
E0217 0 3 Date of Service Edit: Clinical
E0218 0 3 Date of Service Edit: Clinical
E0221 0 3 Date of Service Edit: Clinical
E0225 0 3 Date of Service Edit: Clinical
E0231 0 3 Date of Service Edit: Clinical
E0232 0 3 Date of Service Edit: Clinical
E0235 0 3 Date of Service Edit: Clinical
E0236 0 3 Date of Service Edit: Clinical
E0239 0 3 Date of Service Edit: Clinical
E0240 0 3 Date of Service Edit: Clinical
E0241 0 3 Date of Service Edit: Clinical
E0242 0 3 Date of Service Edit: Clinical
E0243 0 3 Date of Service Edit: Clinical
E0244 0 3 Date of Service Edit: Clinical
E0245 0 3 Date of Service Edit: Clinical
E0246 0 3 Date of Service Edit: Clinical
E0247 0 3 Date of Service Edit: Clinical
E0248 0 3 Date of Service Edit: Clinical
E0249 0 3 Date of Service Edit: Clinical
E0250 0 3 Date of Service Edit: Clinical
E0251 0 3 Date of Service Edit: Clinical
E0255 0 3 Date of Service Edit: Clinical
E0256 0 3 Date of Service Edit: Clinical
E0260 0 3 Date of Service Edit: Clinical
E0261 0 3 Date of Service Edit: Clinical
E0265 0 3 Date of Service Edit: Clinical
E0266 0 3 Date of Service Edit: Clinical
E0270 0 3 Date of Service Edit: Clinical
E0271 0 3 Date of Service Edit: Clinical
E0272 0 3 Date of Service Edit: Clinical
E0273 0 3 Date of Service Edit: Clinical
E0274 0 3 Date of Service Edit: Clinical
E0275 0 3 Date of Service Edit: Clinical
E0276 0 3 Date of Service Edit: Clinical
7
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E0277 0 3 Date of Service Edit: Clinical
E0280 0 3 Date of Service Edit: Clinical
E0290 0 3 Date of Service Edit: Clinical
E0291 0 3 Date of Service Edit: Clinical
E0292 0 3 Date of Service Edit: Clinical
E0293 0 3 Date of Service Edit: Clinical
E0294 0 3 Date of Service Edit: Clinical
E0295 0 3 Date of Service Edit: Clinical
E0296 0 3 Date of Service Edit: Clinical
E0297 0 3 Date of Service Edit: Clinical
E0300 0 3 Date of Service Edit: Clinical
E0301 0 3 Date of Service Edit: Clinical
E0302 0 3 Date of Service Edit: Clinical
E0303 0 3 Date of Service Edit: Clinical
E0304 0 3 Date of Service Edit: Clinical
E0305 0 3 Date of Service Edit: Clinical
E0310 0 3 Date of Service Edit: Clinical
E0315 0 3 Date of Service Edit: Clinical
E0316 0 3 Date of Service Edit: Clinical
E0325 0 3 Date of Service Edit: Clinical
E0326 0 3 Date of Service Edit: Clinical
E0328 0 3 Date of Service Edit: Clinical
E0329 0 3 Date of Service Edit: Clinical
E0350 0 3 Date of Service Edit: Clinical
E0352 0 3 Date of Service Edit: Clinical
E0370 0 3 Date of Service Edit: Clinical
E0371 0 3 Date of Service Edit: Clinical
E0372 0 3 Date of Service Edit: Clinical
E0373 0 3 Date of Service Edit: Clinical
E0424 0 3 Date of Service Edit: Clinical
E0425 0 3 Date of Service Edit: Clinical
E0430 0 3 Date of Service Edit: Clinical
E0431 0 3 Date of Service Edit: Clinical
E0433 0 3 Date of Service Edit: Clinical
E0434 0 3 Date of Service Edit: Clinical
E0435 0 3 Date of Service Edit: Clinical
E0439 0 3 Date of Service Edit: Clinical
E0440 0 3 Date of Service Edit: Clinical
E0441 0 3 Date of Service Edit: Clinical
E0442 0 3 Date of Service Edit: Clinical
E0443 0 3 Date of Service Edit: Clinical
E0444 0 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E0445 0 3 Date of Service Edit: Clinical
E0446 0 3 Date of Service Edit: Clinical
E0450 0 3 Date of Service Edit: Clinical
E0455 0 3 Date of Service Edit: Clinical
E0457 0 3 Date of Service Edit: Clinical
E0459 0 3 Date of Service Edit: Clinical
E0460 0 3 Date of Service Edit: Clinical
E0461 0 3 Date of Service Edit: Clinical
E0462 0 3 Date of Service Edit: Clinical
E0463 0 3 Date of Service Edit: Clinical
E0464 0 3 Date of Service Edit: Clinical
E0470 0 3 Date of Service Edit: Clinical
E0471 0 3 Date of Service Edit: Clinical
E0472 0 3 Date of Service Edit: Clinical
E0480 0 3 Date of Service Edit: Clinical
E0481 0 3 Date of Service Edit: Clinical
E0482 0 3 Date of Service Edit: Clinical
E0483 0 3 Date of Service Edit: Clinical
E0484 0 3 Date of Service Edit: Clinical
E0485 0 3 Date of Service Edit: Clinical
E0486 0 3 Date of Service Edit: Clinical
E0487 0 3 Date of Service Edit: Clinical
E0500 0 3 Date of Service Edit: Clinical
E0550 0 3 Date of Service Edit: Clinical
E0555 0 3 Date of Service Edit: Clinical
E0560 0 3 Date of Service Edit: Clinical
E0561 0 3 Date of Service Edit: Clinical
E0562 0 3 Date of Service Edit: Clinical
E0565 0 3 Date of Service Edit: Clinical
E0570 0 3 Date of Service Edit: Clinical
E0572 0 3 Date of Service Edit: Clinical
E0574 0 3 Date of Service Edit: Clinical
E0575 0 3 Date of Service Edit: Clinical
E0580 0 3 Date of Service Edit: Clinical
E0585 0 3 Date of Service Edit: Clinical
E0600 0 3 Date of Service Edit: Clinical
E0601 0 3 Date of Service Edit: Clinical
E0602 0 3 Date of Service Edit: Clinical
E0603 0 3 Date of Service Edit: Clinical
E0604 0 3 Date of Service Edit: Clinical
E0605 0 3 Date of Service Edit: Clinical
E0606 0 3 Date of Service Edit: Clinical
8
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E0607 0 3 Date of Service Edit: Clinical
E0610 0 3 Date of Service Edit: Clinical
E0615 0 3 Date of Service Edit: Clinical
E0616 1 2 Date of Service Edit: Policy
E0617 0 3 Date of Service Edit: Clinical
E0618 0 3 Date of Service Edit: Clinical
E0619 0 3 Date of Service Edit: Clinical
E0620 0 3 Date of Service Edit: Clinical
E0621 0 3 Date of Service Edit: Clinical
E0625 0 3 Date of Service Edit: Clinical
E0627 0 3 Date of Service Edit: Clinical
E0628 0 3 Date of Service Edit: Clinical
E0629 0 3 Date of Service Edit: Clinical
E0630 0 3 Date of Service Edit: Clinical
E0635 0 3 Date of Service Edit: Clinical
E0636 0 3 Date of Service Edit: Clinical
E0637 0 3 Date of Service Edit: Clinical
E0638 0 3 Date of Service Edit: Clinical
E0639 0 3 Date of Service Edit: Clinical
E0640 0 3 Date of Service Edit: Clinical
E0641 0 3 Date of Service Edit: Clinical
E0642 0 3 Date of Service Edit: Clinical
E0650 0 3 Date of Service Edit: Clinical
E0651 0 3 Date of Service Edit: Clinical
E0652 0 3 Date of Service Edit: Clinical
E0655 0 3 Date of Service Edit: Clinical
E0656 0 3 Date of Service Edit: Clinical
E0657 0 3 Date of Service Edit: Clinical
E0660 0 3 Date of Service Edit: Clinical
E0665 0 3 Date of Service Edit: Clinical
E0666 0 3 Date of Service Edit: Clinical
E0667 0 3 Date of Service Edit: Clinical
E0668 0 3 Date of Service Edit: Clinical
E0669 0 3 Date of Service Edit: Clinical
E0670 0 3 Date of Service Edit: Clinical
E0671 0 3 Date of Service Edit: Clinical
E0672 0 3 Date of Service Edit: Clinical
E0673 0 3 Date of Service Edit: Clinical
E0675 0 3 Date of Service Edit: Clinical
E0676 1 3 Date of Service Edit: Clinical
E0691 0 3 Date of Service Edit: Clinical
E0692 0 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E0693 0 3 Date of Service Edit: Clinical
E0694 0 3 Date of Service Edit: Clinical
E0700 0 3 Date of Service Edit: Clinical
E0705 1 2 Date of Service Edit: Policy
E0710 0 3 Date of Service Edit: Clinical
E0720 0 3 Date of Service Edit: Clinical
E0730 0 3 Date of Service Edit: Clinical
E0731 0 3 Date of Service Edit: Clinical
E0740 0 3 Date of Service Edit: Clinical
E0744 0 3 Date of Service Edit: Clinical
E0745 0 3 Date of Service Edit: Clinical
E0746 1 3 Date of Service Edit: Clinical
E0747 0 3 Date of Service Edit: Clinical
E0748 0 3 Date of Service Edit: Clinical
E0749 1 3 Date of Service Edit: Clinical
E0755 0 3 Date of Service Edit: Clinical
E0760 0 3 Date of Service Edit: Clinical
E0761 0 3 Date of Service Edit: Clinical
E0762 1 3 Date of Service Edit: Clinical
E0764 0 3 Date of Service Edit: Clinical
E0765 0 3 Date of Service Edit: Clinical
E0766 0 3 Date of Service Edit: Clinical
E0769 0 3 Date of Service Edit: Clinical
E0770 1 3 Date of Service Edit: Clinical
E0776 0 3 Date of Service Edit: Clinical
E0779 0 3 Date of Service Edit: Clinical
E0780 0 3 Date of Service Edit: Clinical
E0781 0 3 Date of Service Edit: Clinical
E0782 1 2 Date of Service Edit: Policy
E0783 1 2 Date of Service Edit: Policy
E0784 0 3 Date of Service Edit: Clinical
E0785 1 2 Date of Service Edit: Policy
E0786 1 2 Date of Service Edit: Policy
E0791 0 3 Date of Service Edit: Clinical
E0830 0 3 Date of Service Edit: Clinical
E0840 0 3 Date of Service Edit: Clinical
E0849 0 3 Date of Service Edit: Clinical
E0850 0 3 Date of Service Edit: Clinical
E0855 0 3 Date of Service Edit: Clinical
E0856 0 3 Date of Service Edit: Clinical
E0860 0 3 Date of Service Edit: Clinical
E0870 0 3 Date of Service Edit: Clinical
9
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E0880 0 3 Date of Service Edit: Clinical
E0890 0 3 Date of Service Edit: Clinical
E0900 0 3 Date of Service Edit: Clinical
E0910 0 3 Date of Service Edit: Clinical
E0911 0 3 Date of Service Edit: Clinical
E0912 0 3 Date of Service Edit: Clinical
E0920 0 3 Date of Service Edit: Clinical
E0930 0 3 Date of Service Edit: Clinical
E0935 0 3 Date of Service Edit: Clinical
E0936 0 3 Date of Service Edit: Clinical
E0940 0 3 Date of Service Edit: Clinical
E0941 0 3 Date of Service Edit: Clinical
E0942 0 3 Date of Service Edit: Clinical
E0944 0 3 Date of Service Edit: Clinical
E0945 0 3 Date of Service Edit: Clinical
E0946 0 3 Date of Service Edit: Clinical
E0947 0 3 Date of Service Edit: Clinical
E0948 0 3 Date of Service Edit: Clinical
E0950 0 3 Date of Service Edit: Clinical
E0951 0 3 Date of Service Edit: Clinical
E0952 0 3 Date of Service Edit: Clinical
E0955 0 3 Date of Service Edit: Clinical
E0956 0 3 Date of Service Edit: Clinical
E0957 0 3 Date of Service Edit: Clinical
E0958 0 3 Date of Service Edit: Clinical
E0959 2 1 Line Edit
E0960 0 3 Date of Service Edit: Clinical
E0961 2 1 Line Edit
E0966 1 1 Line Edit
E0967 0 3 Date of Service Edit: Clinical
E0968 0 3 Date of Service Edit: Clinical
E0970 0 3 Date of Service Edit: Clinical
E0971 2 1 Line Edit
E0973 2 1 Line Edit
E0974 2 1 Line Edit
E0978 1 1 Line Edit
E0981 0 3 Date of Service Edit: Clinical
E0982 0 3 Date of Service Edit: Clinical
E0983 0 3 Date of Service Edit: Clinical
E0984 0 3 Date of Service Edit: Clinical
E0985 0 3 Date of Service Edit: Clinical
E0986 0 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E0988 0 3 Date of Service Edit: Clinical
E0990 2 1 Line Edit
E0992 1 1 Line Edit
E0994 0 3 Date of Service Edit: Clinical
E0995 2 1 Line Edit
E1002 0 3 Date of Service Edit: Clinical
E1003 0 3 Date of Service Edit: Clinical
E1004 0 3 Date of Service Edit: Clinical
E1005 0 3 Date of Service Edit: Clinical
E1006 0 3 Date of Service Edit: Clinical
E1007 0 3 Date of Service Edit: Clinical
E1008 0 3 Date of Service Edit: Clinical
E1009 0 3 Date of Service Edit: Clinical
E1010 0 3 Date of Service Edit: Clinical
E1011 0 3 Date of Service Edit: Clinical
E1014 0 3 Date of Service Edit: Clinical
E1015 0 3 Date of Service Edit: Clinical
E1016 0 3 Date of Service Edit: Clinical
E1017 0 3 Date of Service Edit: Clinical
E1018 0 3 Date of Service Edit: Clinical
E1020 0 3 Date of Service Edit: Clinical
E1028 0 3 Date of Service Edit: Clinical
E1029 0 3 Date of Service Edit: Clinical
E1030 0 3 Date of Service Edit: Clinical
E1031 0 3 Date of Service Edit: Clinical
E1035 0 3 Date of Service Edit: Clinical
E1036 0 3 Date of Service Edit: Clinical
E1037 0 3 Date of Service Edit: Clinical
E1038 0 3 Date of Service Edit: Clinical
E1039 0 3 Date of Service Edit: Clinical
E1050 0 3 Date of Service Edit: Clinical
E1060 0 3 Date of Service Edit: Clinical
E1070 0 3 Date of Service Edit: Clinical
E1083 0 3 Date of Service Edit: Clinical
E1084 0 3 Date of Service Edit: Clinical
E1085 0 3 Date of Service Edit: Clinical
E1086 0 3 Date of Service Edit: Clinical
E1087 0 3 Date of Service Edit: Clinical
E1088 0 3 Date of Service Edit: Clinical
E1089 0 3 Date of Service Edit: Clinical
E1090 0 3 Date of Service Edit: Clinical
E1092 0 3 Date of Service Edit: Clinical
10
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E1093 0 3 Date of Service Edit: Clinical
E1100 0 3 Date of Service Edit: Clinical
E1110 0 3 Date of Service Edit: Clinical
E1130 0 3 Date of Service Edit: Clinical
E1140 0 3 Date of Service Edit: Clinical
E1150 0 3 Date of Service Edit: Clinical
E1160 0 3 Date of Service Edit: Clinical
E1161 0 3 Date of Service Edit: Clinical
E1170 0 3 Date of Service Edit: Clinical
E1171 0 3 Date of Service Edit: Clinical
E1172 0 3 Date of Service Edit: Clinical
E1180 0 3 Date of Service Edit: Clinical
E1190 0 3 Date of Service Edit: Clinical
E1195 0 3 Date of Service Edit: Clinical
E1200 0 3 Date of Service Edit: Clinical
E1220 0 3 Date of Service Edit: Clinical
E1221 0 3 Date of Service Edit: Clinical
E1222 0 3 Date of Service Edit: Clinical
E1223 0 3 Date of Service Edit: Clinical
E1224 0 3 Date of Service Edit: Clinical
E1225 0 3 Date of Service Edit: Clinical
E1226 1 1 Line Edit
E1228 0 3 Date of Service Edit: Clinical
E1229 0 3 Date of Service Edit: Clinical
E1230 0 3 Date of Service Edit: Clinical
E1231 0 3 Date of Service Edit: Clinical
E1232 0 3 Date of Service Edit: Clinical
E1233 0 3 Date of Service Edit: Clinical
E1234 0 3 Date of Service Edit: Clinical
E1235 0 3 Date of Service Edit: Clinical
E1236 0 3 Date of Service Edit: Clinical
E1237 0 3 Date of Service Edit: Clinical
E1238 0 3 Date of Service Edit: Clinical
E1239 0 3 Date of Service Edit: Clinical
E1240 0 3 Date of Service Edit: Clinical
E1250 0 3 Date of Service Edit: Clinical
E1260 0 3 Date of Service Edit: Clinical
E1270 0 3 Date of Service Edit: Clinical
E1280 0 3 Date of Service Edit: Clinical
E1285 0 3 Date of Service Edit: Clinical
E1290 0 3 Date of Service Edit: Clinical
E1295 0 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E1300 0 3 Date of Service Edit: Clinical
E1310 0 3 Date of Service Edit: Clinical
E1352 0 3 Date of Service Edit: Clinical
E1353 0 3 Date of Service Edit: Clinical
E1354 0 3 Date of Service Edit: Clinical
E1355 0 3 Date of Service Edit: Clinical
E1356 0 3 Date of Service Edit: Clinical
E1357 0 3 Date of Service Edit: Clinical
E1358 0 3 Date of Service Edit: Clinical
E1372 0 3 Date of Service Edit: Clinical
E1390 0 3 Date of Service Edit: Clinical
E1391 0 3 Date of Service Edit: Clinical
E1392 0 3 Date of Service Edit: Clinical
E1405 0 3 Date of Service Edit: Clinical
E1406 0 3 Date of Service Edit: Clinical
E1500 0 3 Date of Service Edit: Clinical
E1510 0 3 Date of Service Edit: Clinical
E1520 0 3 Date of Service Edit: Clinical
E1530 0 3 Date of Service Edit: Clinical
E1540 0 3 Date of Service Edit: Clinical
E1550 0 3 Date of Service Edit: Clinical
E1560 0 3 Date of Service Edit: Clinical
E1570 0 3 Date of Service Edit: Clinical
E1575 0 3 Date of Service Edit: Clinical
E1580 0 3 Date of Service Edit: Clinical
E1590 0 3 Date of Service Edit: Clinical
E1592 0 3 Date of Service Edit: Clinical
E1594 0 3 Date of Service Edit: Clinical
E1600 0 3 Date of Service Edit: Clinical
E1610 0 3 Date of Service Edit: Clinical
E1615 0 3 Date of Service Edit: Clinical
E1620 0 3 Date of Service Edit: Clinical
E1625 0 3 Date of Service Edit: Clinical
E1630 0 3 Date of Service Edit: Clinical
E1632 0 3 Date of Service Edit: Clinical
E1634 0 3 Date of Service Edit: Clinical
E1635 0 3 Date of Service Edit: Clinical
E1636 0 3 Date of Service Edit: Clinical
E1637 0 3 Date of Service Edit: Clinical
E1639 0 3 Date of Service Edit: Clinical
E1700 0 3 Date of Service Edit: Clinical
E1701 0 3 Date of Service Edit: Clinical
11
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E1702 0 3 Date of Service Edit: Clinical
E1800 0 3 Date of Service Edit: Clinical
E1801 0 3 Date of Service Edit: Clinical
E1802 0 3 Date of Service Edit: Clinical
E1805 0 3 Date of Service Edit: Clinical
E1806 0 3 Date of Service Edit: Clinical
E1810 0 3 Date of Service Edit: Clinical
E1811 0 3 Date of Service Edit: Clinical
E1812 0 3 Date of Service Edit: Clinical
E1815 0 3 Date of Service Edit: Clinical
E1816 0 3 Date of Service Edit: Clinical
E1818 0 3 Date of Service Edit: Clinical
E1820 0 3 Date of Service Edit: Clinical
E1821 0 3 Date of Service Edit: Clinical
E1825 0 3 Date of Service Edit: Clinical
E1830 0 3 Date of Service Edit: Clinical
E1831 0 3 Date of Service Edit: Clinical
E1840 0 3 Date of Service Edit: Clinical
E1841 0 3 Date of Service Edit: Clinical
E1902 0 3 Date of Service Edit: Clinical
E2000 0 3 Date of Service Edit: Clinical
E2100 0 3 Date of Service Edit: Clinical
E2101 0 3 Date of Service Edit: Clinical
E2120 0 3 Date of Service Edit: Clinical
E2201 0 3 Date of Service Edit: Clinical
E2202 0 3 Date of Service Edit: Clinical
E2203 0 3 Date of Service Edit: Clinical
E2204 0 3 Date of Service Edit: Clinical
E2205 0 3 Date of Service Edit: Clinical
E2206 0 3 Date of Service Edit: Clinical
E2207 0 3 Date of Service Edit: Clinical
E2208 0 3 Date of Service Edit: Clinical
E2209 0 3 Date of Service Edit: Clinical
E2210 0 3 Date of Service Edit: Clinical
E2211 0 3 Date of Service Edit: Clinical
E2212 0 3 Date of Service Edit: Clinical
E2213 0 3 Date of Service Edit: Clinical
E2214 0 3 Date of Service Edit: Clinical
E2215 0 3 Date of Service Edit: Clinical
E2216 0 3 Date of Service Edit: Clinical
E2217 0 3 Date of Service Edit: Clinical
E2218 0 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E2219 0 3 Date of Service Edit: Clinical
E2220 0 3 Date of Service Edit: Clinical
E2221 0 3 Date of Service Edit: Clinical
E2222 0 3 Date of Service Edit: Clinical
E2224 0 3 Date of Service Edit: Clinical
E2225 0 3 Date of Service Edit: Clinical
E2226 0 3 Date of Service Edit: Clinical
E2227 0 3 Date of Service Edit: Clinical
E2228 0 3 Date of Service Edit: Clinical
E2231 0 3 Date of Service Edit: Clinical
E2291 1 2 Date of Service Edit: Policy
E2292 1 2 Date of Service Edit: Policy
E2293 1 2 Date of Service Edit: Policy
E2294 1 2 Date of Service Edit: Policy
E2295 0 3 Date of Service Edit: Clinical
E2300 0 3 Date of Service Edit: Clinical
E2301 0 3 Date of Service Edit: Clinical
E2310 0 3 Date of Service Edit: Clinical
E2311 0 3 Date of Service Edit: Clinical
E2312 0 3 Date of Service Edit: Clinical
E2313 0 3 Date of Service Edit: Clinical
E2321 0 3 Date of Service Edit: Clinical
E2322 0 3 Date of Service Edit: Clinical
E2323 0 3 Date of Service Edit: Clinical
E2324 0 3 Date of Service Edit: Clinical
E2325 0 3 Date of Service Edit: Clinical
E2326 0 3 Date of Service Edit: Clinical
E2327 0 3 Date of Service Edit: Clinical
E2328 0 3 Date of Service Edit: Clinical
E2329 0 3 Date of Service Edit: Clinical
E2330 0 3 Date of Service Edit: Clinical
E2331 0 3 Date of Service Edit: Clinical
E2340 0 3 Date of Service Edit: Clinical
E2341 0 3 Date of Service Edit: Clinical
E2342 0 3 Date of Service Edit: Clinical
E2343 0 3 Date of Service Edit: Clinical
E2351 0 3 Date of Service Edit: Clinical
E2358 0 3 Date of Service Edit: Clinical
E2359 0 3 Date of Service Edit: Clinical
E2361 0 3 Date of Service Edit: Clinical
E2363 0 3 Date of Service Edit: Clinical
E2365 0 3 Date of Service Edit: Clinical
12
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E2366 0 3 Date of Service Edit: Clinical
E2367 0 3 Date of Service Edit: Clinical
E2368 0 3 Date of Service Edit: Clinical
E2369 0 3 Date of Service Edit: Clinical
E2370 0 3 Date of Service Edit: Clinical
E2371 0 3 Date of Service Edit: Clinical
E2373 0 3 Date of Service Edit: Clinical
E2374 0 3 Date of Service Edit: Clinical
E2375 0 3 Date of Service Edit: Clinical
E2376 0 3 Date of Service Edit: Clinical
E2377 0 3 Date of Service Edit: Clinical
E2378 0 3 Date of Service Edit: Clinical
E2381 0 3 Date of Service Edit: Clinical
E2382 0 3 Date of Service Edit: Clinical
E2383 0 3 Date of Service Edit: Clinical
E2384 0 3 Date of Service Edit: Clinical
E2385 0 3 Date of Service Edit: Clinical
E2386 0 3 Date of Service Edit: Clinical
E2387 0 3 Date of Service Edit: Clinical
E2388 0 3 Date of Service Edit: Clinical
E2389 0 3 Date of Service Edit: Clinical
E2390 0 3 Date of Service Edit: Clinical
E2391 0 3 Date of Service Edit: Clinical
E2392 0 3 Date of Service Edit: Clinical
E2394 0 3 Date of Service Edit: Clinical
E2395 0 3 Date of Service Edit: Clinical
E2396 0 3 Date of Service Edit: Clinical
E2397 0 3 Date of Service Edit: Clinical
E2402 0 3 Date of Service Edit: Clinical
E2500 0 3 Date of Service Edit: Clinical
E2502 0 3 Date of Service Edit: Clinical
E2504 0 3 Date of Service Edit: Clinical
E2506 0 3 Date of Service Edit: Clinical
E2508 0 3 Date of Service Edit: Clinical
E2510 0 3 Date of Service Edit: Clinical
E2511 0 3 Date of Service Edit: Clinical
E2512 0 3 Date of Service Edit: Clinical
E2601 0 3 Date of Service Edit: Clinical
E2602 0 3 Date of Service Edit: Clinical
E2603 0 3 Date of Service Edit: Clinical
E2604 0 3 Date of Service Edit: Clinical
E2605 0 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
E2606 0 3 Date of Service Edit: Clinical
E2607 0 3 Date of Service Edit: Clinical
E2608 0 3 Date of Service Edit: Clinical
E2609 0 3 Date of Service Edit: Clinical
E2611 0 3 Date of Service Edit: Clinical
E2612 0 3 Date of Service Edit: Clinical
E2613 0 3 Date of Service Edit: Clinical
E2614 0 3 Date of Service Edit: Clinical
E2615 0 3 Date of Service Edit: Clinical
E2616 0 3 Date of Service Edit: Clinical
E2617 0 3 Date of Service Edit: Clinical
E2619 0 3 Date of Service Edit: Clinical
E2620 0 3 Date of Service Edit: Clinical
E2621 0 3 Date of Service Edit: Clinical
E2622 0 3 Date of Service Edit: Clinical
E2623 0 3 Date of Service Edit: Clinical
E2624 0 3 Date of Service Edit: Clinical
E2625 0 3 Date of Service Edit: Clinical
E2626 0 3 Date of Service Edit: Clinical
E2627 0 3 Date of Service Edit: Clinical
E2628 0 3 Date of Service Edit: Clinical
E2629 0 3 Date of Service Edit: Clinical
E2630 0 3 Date of Service Edit: Clinical
E2631 0 3 Date of Service Edit: Clinical
E2632 0 3 Date of Service Edit: Clinical
E2633 0 3 Date of Service Edit: Clinical
G0008 1 2 Date of Service Edit: Policy
G0009 1 2 Date of Service Edit: Policy
G0010 2 1 Line Edit
G0027 1 2 Date of Service Edit: Policy
G0101 1 2 Date of Service Edit: Policy
G0102 1 2 Date of Service Edit: Policy
G0103 1 2 Date of Service Edit: Policy
G0104 1 2 Date of Service Edit: Policy
G0105 1 2 Date of Service Edit: Policy
G0106 1 2 Date of Service Edit: Policy
G0117 1 2 Date of Service Edit: Policy
G0118 1 2 Date of Service Edit: Policy
G0120 1 2 Date of Service Edit: Policy
G0121 1 2 Date of Service Edit: Policy
G0123 1 3 Date of Service Edit: Clinical
G0124 1 3 Date of Service Edit: Clinical
13
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
G0127 1 2 Date of Service Edit: Policy
G0128 1 1 Line Edit
G0129 3 1 Line Edit
G0130 1 2 Date of Service Edit: Policy
G0141 1 3 Date of Service Edit: Clinical
G0143 1 3 Date of Service Edit: Clinical
G0144 1 3 Date of Service Edit: Clinical
G0145 1 3 Date of Service Edit: Clinical
G0147 1 3 Date of Service Edit: Clinical
G0148 1 3 Date of Service Edit: Clinical
G0166 2 1 Line Edit
G0168 2 1 Line Edit
G0173 1 2 Date of Service Edit: Policy
G0175 1 3 Date of Service Edit: Clinical
G0176 5 1 Line Edit
G0177 3 3 Date of Service Edit: Clinical
G0179 1 2 Date of Service Edit: Policy
G0180 1 2 Date of Service Edit: Policy
G0181 1 2 Date of Service Edit: Policy
G0182 1 2 Date of Service Edit: Policy
G0186 1 2 Date of Service Edit: Policy
G0202 1 2 Date of Service Edit: Policy
G0204 2 3 Date of Service Edit: Clinical
G0206 2 3 Date of Service Edit: Clinical
G0235 1 3 Date of Service Edit: Clinical
G0239 2 1 Line Edit
G0245 1 2 Date of Service Edit: Policy
G0246 1 2 Date of Service Edit: Policy
G0247 1 2 Date of Service Edit: Policy
G0248 1 2 Date of Service Edit: Policy
G0249 3 1 Line Edit
G0250 1 2 Date of Service Edit: Policy
G0251 2 3 Date of Service Edit: Clinical
G0257 2 1 Line Edit
G0259 2 3 Date of Service Edit: Clinical
G0260 2 3 Date of Service Edit: Clinical
G0268 1 2 Date of Service Edit: Policy
G0278 1 2 Date of Service Edit: Policy
G0281 1 1 Line Edit
G0283 1 1 Line Edit
G0288 1 2 Date of Service Edit: Policy
G0289 1 2 Date of Service Edit: Policy
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
G0293 1 2 Date of Service Edit: Policy
G0294 1 2 Date of Service Edit: Policy
G0302 1 2 Date of Service Edit: Policy
G0303 1 2 Date of Service Edit: Policy
G0304 1 2 Date of Service Edit: Policy
G0305 1 2 Date of Service Edit: Policy
G0306 2 1 Line Edit
G0307 2 1 Line Edit
G0328 1 2 Date of Service Edit: Policy
G0329 1 1 Line Edit
G0333 0 3 Date of Service Edit: Clinical
G0337 1 2 Date of Service Edit: Policy
G0339 1 2 Date of Service Edit: Policy
G0340 2 3 Date of Service Edit: Clinical
G0341 1 2 Date of Service Edit: Policy
G0342 1 2 Date of Service Edit: Policy
G0343 1 2 Date of Service Edit: Policy
G0364 2 1 Line Edit
G0365 2 1 Line Edit
G0372 1 2 Date of Service Edit: Policy
G0379 1 2 Date of Service Edit: Policy
G0380 2 1 Line Edit
G0381 2 1 Line Edit
G0382 2 1 Line Edit
G0383 2 1 Line Edit
G0384 2 1 Line Edit
G0389 1 2 Date of Service Edit: Policy
G0390 1 2 Date of Service Edit: Policy
G0396 1 2 Date of Service Edit: Policy
G0397 1 2 Date of Service Edit: Policy
G0398 1 2 Date of Service Edit: Policy
G0399 1 2 Date of Service Edit: Policy
G0400 1 2 Date of Service Edit: Policy
G0402 1 2 Date of Service Edit: Policy
G0403 1 2 Date of Service Edit: Policy
G0404 1 2 Date of Service Edit: Policy
G0405 1 2 Date of Service Edit: Policy
G0412 1 2 Date of Service Edit: Policy
G0413 1 2 Date of Service Edit: Policy
G0414 1 2 Date of Service Edit: Policy
G0415 1 2 Date of Service Edit: Policy
G0416 1 2 Date of Service Edit: Policy
14
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
G0417 1 2 Date of Service Edit: Policy
G0418 1 2 Date of Service Edit: Policy
G0419 1 2 Date of Service Edit: Policy
G0420 2 3 Date of Service Edit: Clinical
G0424 2 2 Date of Service Edit: Policy
G0429 1 2 Date of Service Edit: Policy
G0431 1 2 Date of Service Edit: Policy
G0432 1 2 Date of Service Edit: Policy
G0433 1 2 Date of Service Edit: Policy
G0434 1 2 Date of Service Edit: Policy
G0435 1 2 Date of Service Edit: Policy
G0436 1 2 Date of Service Edit: Policy
G0437 1 2 Date of Service Edit: Policy
G0438 1 2 Date of Service Edit: Policy
G0439 1 2 Date of Service Edit: Policy
G0442 1 2 Date of Service Edit: Policy
G0443 1 2 Date of Service Edit: Policy
G0444 1 2 Date of Service Edit: Policy
G0445 1 2 Date of Service Edit: Policy
G0448 1 3 Date of Service Edit: Clinical
G0452 1 1 Line Edit
G0454 1 2 Date of Service Edit: Policy
G0455 1 2 Date of Service Edit: Policy
G0456 1 2 Date of Service Edit: Policy
G0457 1 2 Date of Service Edit: Policy
G0458 1 1 Line Edit
G0459 0 3 Date of Service Edit: Clinical
G0460 1 3 Date of Service Edit: Clinical
G0461 9 3 Date of Service Edit: Clinical
G0462 60 3 Date of Service Edit: Clinical
G0463 6 3 Date of Service Edit: Clinical
G3001 1 2 Date of Service Edit: Policy
G9143 1 2 Date of Service Edit: Policy
G9156 1 2 Date of Service Edit: Policy
G9157 1 2 Date of Service Edit: Policy
G9187 0 3 Date of Service Edit: Clinical
J0130 6 3 Date of Service Edit: Clinical
J0131 400 3 Date of Service Edit: Clinical
J0133 1200 3 Date of Service Edit: Clinical
J0135 8 3 Date of Service Edit: Clinical
J0151 180 3 Date of Service Edit: Clinical
J0178 4 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
J0210 16 3 Date of Service Edit: Clinical
J0215 30 3 Date of Service Edit: Clinical
J0220 20 3 Date of Service Edit: Clinical
J0221 300 3 Date of Service Edit: Clinical
J0256 3500 3 Date of Service Edit: Clinical
J0257 1400 3 Date of Service Edit: Clinical
J0275 1 3 Date of Service Edit: Clinical
J0278 15 3 Date of Service Edit: Clinical
J0280 10 3 Date of Service Edit: Clinical
J0289 115 3 Date of Service Edit: Clinical
J0300 8 3 Date of Service Edit: Clinical
J0348 200 3 Date of Service Edit: Clinical
J0350 0 3 Date of Service Edit: Clinical
J0360 6 3 Date of Service Edit: Clinical
J0364 6 3 Date of Service Edit: Clinical
J0456 4 3 Date of Service Edit: Clinical
J0475 8 3 Date of Service Edit: Clinical
J0485 1500 3 Date of Service Edit: Clinical
J0490 160 3 Date of Service Edit: Clinical
J0597 250 3 Date of Service Edit: Clinical
J0638 150 3 Date of Service Edit: Clinical
J0697 12 3 Date of Service Edit: Clinical
J0712 180 3 Date of Service Edit: Clinical
J0717 400 3 Date of Service Edit: Clinical
J0745 8 3 Date of Service Edit: Clinical
J0760 4 3 Date of Service Edit: Clinical
J0770 5 3 Date of Service Edit: Clinical
J0780 10 3 Date of Service Edit: Clinical
J0800 3 3 Date of Service Edit: Clinical
J0833 3 3 Date of Service Edit: Clinical
J0890 0 3 Date of Service Edit: Clinical
J0897 120 3 Date of Service Edit: Clinical
J0900 1 3 Date of Service Edit: Clinical
J0945 4 3 Date of Service Edit: Clinical
J1050 1000 3 Date of Service Edit: Clinical
J1162 10 3 Date of Service Edit: Clinical
J1442 3360 3 Date of Service Edit: Clinical
J1446 192 3 Date of Service Edit: Clinical
J1556 300 3 Date of Service Edit: Clinical
J1557 300 3 Date of Service Edit: Clinical
J1561 300 3 Date of Service Edit: Clinical
J1568 300 3 Date of Service Edit: Clinical
15
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
J1569 300 3 Date of Service Edit: Clinical
J1572 300 3 Date of Service Edit: Clinical
J1725 250 3 Date of Service Edit: Clinical
J1744 90 3 Date of Service Edit: Clinical
J2212 240 3 Date of Service Edit: Clinical
J2265 400 3 Date of Service Edit: Clinical
J2507 8 3 Date of Service Edit: Clinical
J2995 0 3 Date of Service Edit: Clinical
J3010 100 3 Date of Service Edit: Clinical
J3060 900 3 Date of Service Edit: Clinical
J3285 9 3 Date of Service Edit: Clinical
J3465 120 3 Date of Service Edit: Clinical
J3489 5 3 Date of Service Edit: Clinical
J7196 175 3 Date of Service Edit: Clinical
J7301 0 3 Date of Service Edit: Clinical
J7310 2 2 Date of Service Edit: Policy
J7316 4 2 Date of Service Edit: Policy
J7326 2 2 Date of Service Edit: Policy
J7527 20 3 Date of Service Edit: Clinical
J7604 0 3 Date of Service Edit: Clinical
J7607 0 3 Date of Service Edit: Clinical
J7609 0 3 Date of Service Edit: Clinical
J7610 0 3 Date of Service Edit: Clinical
J7615 0 3 Date of Service Edit: Clinical
J7622 0 3 Date of Service Edit: Clinical
J7624 0 3 Date of Service Edit: Clinical
J7627 0 3 Date of Service Edit: Clinical
J7628 0 3 Date of Service Edit: Clinical
J7629 0 3 Date of Service Edit: Clinical
J7632 0 3 Date of Service Edit: Clinical
J7634 0 3 Date of Service Edit: Clinical
J7635 0 3 Date of Service Edit: Clinical
J7636 0 3 Date of Service Edit: Clinical
J7637 0 3 Date of Service Edit: Clinical
J7638 0 3 Date of Service Edit: Clinical
J7640 0 3 Date of Service Edit: Clinical
J7641 0 3 Date of Service Edit: Clinical
J7642 0 3 Date of Service Edit: Clinical
J7643 0 3 Date of Service Edit: Clinical
J7645 0 3 Date of Service Edit: Clinical
J7647 0 3 Date of Service Edit: Clinical
J7650 0 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
J7657 0 3 Date of Service Edit: Clinical
J7660 0 3 Date of Service Edit: Clinical
J7665 127 2 Date of Service Edit: Policy
J7667 0 3 Date of Service Edit: Clinical
J7670 0 3 Date of Service Edit: Clinical
J7676 0 3 Date of Service Edit: Clinical
J7680 0 3 Date of Service Edit: Clinical
J7681 0 3 Date of Service Edit: Clinical
J7683 0 3 Date of Service Edit: Clinical
J7684 0 3 Date of Service Edit: Clinical
J7685 0 3 Date of Service Edit: Clinical
J8510 5 3 Date of Service Edit: Clinical
J9019 60 3 Date of Service Edit: Clinical
J9042 200 3 Date of Service Edit: Clinical
J9047 120 3 Date of Service Edit: Clinical
J9179 50 3 Date of Service Edit: Clinical
J9228 450 3 Date of Service Edit: Clinical
J9262 700 3 Date of Service Edit: Clinical
J9306 840 3 Date of Service Edit: Clinical
J9354 600 3 Date of Service Edit: Clinical
J9355 100 3 Date of Service Edit: Clinical
J9400 600 3 Date of Service Edit: Clinical
K0001 0 3 Date of Service Edit: Clinical
K0002 0 3 Date of Service Edit: Clinical
K0003 0 3 Date of Service Edit: Clinical
K0004 0 3 Date of Service Edit: Clinical
K0005 0 3 Date of Service Edit: Clinical
K0006 0 3 Date of Service Edit: Clinical
K0007 0 3 Date of Service Edit: Clinical
K0008 0 3 Date of Service Edit: Clinical
K0009 0 3 Date of Service Edit: Clinical
K0013 0 3 Date of Service Edit: Clinical
K0015 0 3 Date of Service Edit: Clinical
K0017 0 3 Date of Service Edit: Clinical
K0018 0 3 Date of Service Edit: Clinical
K0019 0 3 Date of Service Edit: Clinical
K0020 0 3 Date of Service Edit: Clinical
K0037 0 3 Date of Service Edit: Clinical
K0038 0 3 Date of Service Edit: Clinical
K0039 0 3 Date of Service Edit: Clinical
K0040 0 3 Date of Service Edit: Clinical
K0041 0 3 Date of Service Edit: Clinical
16
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
K0042 0 3 Date of Service Edit: Clinical
K0043 0 3 Date of Service Edit: Clinical
K0044 0 3 Date of Service Edit: Clinical
K0045 0 3 Date of Service Edit: Clinical
K0046 0 3 Date of Service Edit: Clinical
K0047 0 3 Date of Service Edit: Clinical
K0050 0 3 Date of Service Edit: Clinical
K0051 0 3 Date of Service Edit: Clinical
K0052 0 3 Date of Service Edit: Clinical
K0053 0 3 Date of Service Edit: Clinical
K0056 0 3 Date of Service Edit: Clinical
K0065 0 3 Date of Service Edit: Clinical
K0069 0 3 Date of Service Edit: Clinical
K0070 0 3 Date of Service Edit: Clinical
K0071 0 3 Date of Service Edit: Clinical
K0072 0 3 Date of Service Edit: Clinical
K0073 0 3 Date of Service Edit: Clinical
K0077 0 3 Date of Service Edit: Clinical
K0105 0 3 Date of Service Edit: Clinical
K0195 0 3 Date of Service Edit: Clinical
K0455 0 3 Date of Service Edit: Clinical
K0462 0 3 Date of Service Edit: Clinical
K0552 0 3 Date of Service Edit: Clinical
K0601 0 3 Date of Service Edit: Clinical
K0602 0 3 Date of Service Edit: Clinical
K0603 0 3 Date of Service Edit: Clinical
K0604 0 3 Date of Service Edit: Clinical
K0605 0 3 Date of Service Edit: Clinical
K0606 0 3 Date of Service Edit: Clinical
K0607 0 3 Date of Service Edit: Clinical
K0608 0 3 Date of Service Edit: Clinical
K0609 0 3 Date of Service Edit: Clinical
K0730 0 3 Date of Service Edit: Clinical
K0733 0 3 Date of Service Edit: Clinical
K0738 0 3 Date of Service Edit: Clinical
K0743 0 3 Date of Service Edit: Clinical
K0800 0 3 Date of Service Edit: Clinical
K0801 0 3 Date of Service Edit: Clinical
K0802 0 3 Date of Service Edit: Clinical
K0806 0 3 Date of Service Edit: Clinical
K0807 0 3 Date of Service Edit: Clinical
K0808 0 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
K0812 0 3 Date of Service Edit: Clinical
K0813 0 3 Date of Service Edit: Clinical
K0814 0 3 Date of Service Edit: Clinical
K0815 0 3 Date of Service Edit: Clinical
K0816 0 3 Date of Service Edit: Clinical
K0820 0 3 Date of Service Edit: Clinical
K0821 0 3 Date of Service Edit: Clinical
K0822 0 3 Date of Service Edit: Clinical
K0823 0 3 Date of Service Edit: Clinical
K0824 0 3 Date of Service Edit: Clinical
K0825 0 3 Date of Service Edit: Clinical
K0826 0 3 Date of Service Edit: Clinical
K0827 0 3 Date of Service Edit: Clinical
K0828 0 3 Date of Service Edit: Clinical
K0829 0 3 Date of Service Edit: Clinical
K0830 0 3 Date of Service Edit: Clinical
K0831 0 3 Date of Service Edit: Clinical
K0835 0 3 Date of Service Edit: Clinical
K0836 0 3 Date of Service Edit: Clinical
K0837 0 3 Date of Service Edit: Clinical
K0838 0 3 Date of Service Edit: Clinical
K0839 0 3 Date of Service Edit: Clinical
K0840 0 3 Date of Service Edit: Clinical
K0841 0 3 Date of Service Edit: Clinical
K0842 0 3 Date of Service Edit: Clinical
K0843 0 3 Date of Service Edit: Clinical
K0848 0 3 Date of Service Edit: Clinical
K0849 0 3 Date of Service Edit: Clinical
K0850 0 3 Date of Service Edit: Clinical
K0851 0 3 Date of Service Edit: Clinical
K0852 0 3 Date of Service Edit: Clinical
K0853 0 3 Date of Service Edit: Clinical
K0854 0 3 Date of Service Edit: Clinical
K0855 0 3 Date of Service Edit: Clinical
K0856 0 3 Date of Service Edit: Clinical
K0857 0 3 Date of Service Edit: Clinical
K0858 0 3 Date of Service Edit: Clinical
K0859 0 3 Date of Service Edit: Clinical
K0860 0 3 Date of Service Edit: Clinical
K0861 0 3 Date of Service Edit: Clinical
K0862 0 3 Date of Service Edit: Clinical
K0863 0 3 Date of Service Edit: Clinical
17
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
K0864 0 3 Date of Service Edit: Clinical
K0868 0 3 Date of Service Edit: Clinical
K0869 0 3 Date of Service Edit: Clinical
K0870 0 3 Date of Service Edit: Clinical
K0871 0 3 Date of Service Edit: Clinical
K0877 0 3 Date of Service Edit: Clinical
K0878 0 3 Date of Service Edit: Clinical
K0879 0 3 Date of Service Edit: Clinical
K0880 0 3 Date of Service Edit: Clinical
K0884 0 3 Date of Service Edit: Clinical
K0885 0 3 Date of Service Edit: Clinical
K0886 0 3 Date of Service Edit: Clinical
K0890 0 3 Date of Service Edit: Clinical
K0891 0 3 Date of Service Edit: Clinical
K0898 1 2 Date of Service Edit: Policy
K0900 0 3 Date of Service Edit: Clinical
L0112 1 2 Date of Service Edit: Policy
L0113 1 2 Date of Service Edit: Policy
L0120 1 2 Date of Service Edit: Policy
L0130 1 2 Date of Service Edit: Policy
L0140 1 2 Date of Service Edit: Policy
L0150 1 2 Date of Service Edit: Policy
L0160 1 2 Date of Service Edit: Policy
L0170 1 2 Date of Service Edit: Policy
L0172 1 2 Date of Service Edit: Policy
L0174 1 2 Date of Service Edit: Policy
L0180 1 2 Date of Service Edit: Policy
L0190 1 2 Date of Service Edit: Policy
L0200 1 2 Date of Service Edit: Policy
L0220 1 3 Date of Service Edit: Clinical
L0450 1 2 Date of Service Edit: Policy
L0452 1 2 Date of Service Edit: Policy
L0454 1 2 Date of Service Edit: Policy
L0455 1 2 Date of Service Edit: Policy
L0456 1 2 Date of Service Edit: Policy
L0457 1 2 Date of Service Edit: Policy
L0458 1 2 Date of Service Edit: Policy
L0460 1 2 Date of Service Edit: Policy
L0462 1 2 Date of Service Edit: Policy
L0464 1 2 Date of Service Edit: Policy
L0466 1 2 Date of Service Edit: Policy
L0467 1 2 Date of Service Edit: Policy
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L0468 1 2 Date of Service Edit: Policy
L0469 1 2 Date of Service Edit: Policy
L0470 1 2 Date of Service Edit: Policy
L0472 1 2 Date of Service Edit: Policy
L0480 1 2 Date of Service Edit: Policy
L0482 1 2 Date of Service Edit: Policy
L0484 1 2 Date of Service Edit: Policy
L0486 1 2 Date of Service Edit: Policy
L0488 1 2 Date of Service Edit: Policy
L0490 1 2 Date of Service Edit: Policy
L0491 1 2 Date of Service Edit: Policy
L0492 1 2 Date of Service Edit: Policy
L0621 1 2 Date of Service Edit: Policy
L0622 1 2 Date of Service Edit: Policy
L0623 1 2 Date of Service Edit: Policy
L0624 1 2 Date of Service Edit: Policy
L0625 1 2 Date of Service Edit: Policy
L0626 1 2 Date of Service Edit: Policy
L0627 1 2 Date of Service Edit: Policy
L0628 1 2 Date of Service Edit: Policy
L0629 1 2 Date of Service Edit: Policy
L0630 1 2 Date of Service Edit: Policy
L0631 1 2 Date of Service Edit: Policy
L0632 1 2 Date of Service Edit: Policy
L0633 1 2 Date of Service Edit: Policy
L0634 1 2 Date of Service Edit: Policy
L0635 1 2 Date of Service Edit: Policy
L0636 1 2 Date of Service Edit: Policy
L0637 1 2 Date of Service Edit: Policy
L0638 1 2 Date of Service Edit: Policy
L0639 1 2 Date of Service Edit: Policy
L0640 1 2 Date of Service Edit: Policy
L0641 1 2 Date of Service Edit: Policy
L0642 1 2 Date of Service Edit: Policy
L0643 1 2 Date of Service Edit: Policy
L0648 1 2 Date of Service Edit: Policy
L0649 1 2 Date of Service Edit: Policy
L0650 1 2 Date of Service Edit: Policy
L0651 1 2 Date of Service Edit: Policy
L0700 1 2 Date of Service Edit: Policy
L0710 1 2 Date of Service Edit: Policy
L0810 1 2 Date of Service Edit: Policy
18
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L0820 1 2 Date of Service Edit: Policy
L0830 1 2 Date of Service Edit: Policy
L0859 1 2 Date of Service Edit: Policy
L0861 1 2 Date of Service Edit: Policy
L0970 1 2 Date of Service Edit: Policy
L0972 1 2 Date of Service Edit: Policy
L0974 1 2 Date of Service Edit: Policy
L0976 1 2 Date of Service Edit: Policy
L0978 2 3 Date of Service Edit: Clinical
L0980 1 2 Date of Service Edit: Policy
L0982 1 3 Date of Service Edit: Clinical
L0984 3 3 Date of Service Edit: Clinical
L1000 1 2 Date of Service Edit: Policy
L1001 1 2 Date of Service Edit: Policy
L1005 1 2 Date of Service Edit: Policy
L1010 2 2 Date of Service Edit: Policy
L1020 2 3 Date of Service Edit: Clinical
L1025 1 3 Date of Service Edit: Clinical
L1030 1 3 Date of Service Edit: Clinical
L1040 1 3 Date of Service Edit: Clinical
L1050 1 3 Date of Service Edit: Clinical
L1060 1 3 Date of Service Edit: Clinical
L1070 2 2 Date of Service Edit: Policy
L1080 2 2 Date of Service Edit: Policy
L1085 1 2 Date of Service Edit: Policy
L1090 1 3 Date of Service Edit: Clinical
L1100 2 2 Date of Service Edit: Policy
L1110 2 2 Date of Service Edit: Policy
L1120 3 3 Date of Service Edit: Clinical
L1200 1 2 Date of Service Edit: Policy
L1210 2 3 Date of Service Edit: Clinical
L1220 1 3 Date of Service Edit: Clinical
L1230 1 2 Date of Service Edit: Policy
L1240 1 3 Date of Service Edit: Clinical
L1250 2 3 Date of Service Edit: Clinical
L1260 1 3 Date of Service Edit: Clinical
L1270 3 3 Date of Service Edit: Clinical
L1280 2 3 Date of Service Edit: Clinical
L1290 2 3 Date of Service Edit: Clinical
L1300 1 2 Date of Service Edit: Policy
L1310 1 2 Date of Service Edit: Policy
L1499 1 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L1600 1 2 Date of Service Edit: Policy
L1610 1 2 Date of Service Edit: Policy
L1620 1 2 Date of Service Edit: Policy
L1630 1 2 Date of Service Edit: Policy
L1640 1 2 Date of Service Edit: Policy
L1650 1 2 Date of Service Edit: Policy
L1652 1 2 Date of Service Edit: Policy
L1660 1 2 Date of Service Edit: Policy
L1680 1 2 Date of Service Edit: Policy
L1685 1 2 Date of Service Edit: Policy
L1686 1 3 Date of Service Edit: Clinical
L1690 1 2 Date of Service Edit: Policy
L1700 1 2 Date of Service Edit: Policy
L1710 1 2 Date of Service Edit: Policy
L1720 2 2 Date of Service Edit: Policy
L1730 1 2 Date of Service Edit: Policy
L1755 2 2 Date of Service Edit: Policy
L1810 2 2 Date of Service Edit: Policy
L1812 2 2 Date of Service Edit: Policy
L1820 2 2 Date of Service Edit: Policy
L1830 2 2 Date of Service Edit: Policy
L1831 2 2 Date of Service Edit: Policy
L1832 2 2 Date of Service Edit: Policy
L1833 2 2 Date of Service Edit: Policy
L1834 2 2 Date of Service Edit: Policy
L1836 2 2 Date of Service Edit: Policy
L1840 2 2 Date of Service Edit: Policy
L1843 2 2 Date of Service Edit: Policy
L1844 2 2 Date of Service Edit: Policy
L1845 2 2 Date of Service Edit: Policy
L1846 2 2 Date of Service Edit: Policy
L1847 2 2 Date of Service Edit: Policy
L1848 2 2 Date of Service Edit: Policy
L1850 2 2 Date of Service Edit: Policy
L1860 2 2 Date of Service Edit: Policy
L1900 2 2 Date of Service Edit: Policy
L1902 2 2 Date of Service Edit: Policy
L1904 2 2 Date of Service Edit: Policy
L1906 2 2 Date of Service Edit: Policy
L1907 2 2 Date of Service Edit: Policy
L1910 2 2 Date of Service Edit: Policy
L1920 2 2 Date of Service Edit: Policy
19
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L1930 2 2 Date of Service Edit: Policy
L1932 2 2 Date of Service Edit: Policy
L1940 2 2 Date of Service Edit: Policy
L1945 2 2 Date of Service Edit: Policy
L1950 2 2 Date of Service Edit: Policy
L1951 2 2 Date of Service Edit: Policy
L1960 2 2 Date of Service Edit: Policy
L1970 2 2 Date of Service Edit: Policy
L1971 2 2 Date of Service Edit: Policy
L1980 2 2 Date of Service Edit: Policy
L1990 2 2 Date of Service Edit: Policy
L2000 2 2 Date of Service Edit: Policy
L2005 2 2 Date of Service Edit: Policy
L2010 2 2 Date of Service Edit: Policy
L2020 2 2 Date of Service Edit: Policy
L2030 2 2 Date of Service Edit: Policy
L2034 2 2 Date of Service Edit: Policy
L2035 2 2 Date of Service Edit: Policy
L2036 2 2 Date of Service Edit: Policy
L2037 2 2 Date of Service Edit: Policy
L2038 2 2 Date of Service Edit: Policy
L2040 1 2 Date of Service Edit: Policy
L2050 1 2 Date of Service Edit: Policy
L2060 1 2 Date of Service Edit: Policy
L2070 1 2 Date of Service Edit: Policy
L2080 1 2 Date of Service Edit: Policy
L2090 1 2 Date of Service Edit: Policy
L2106 2 2 Date of Service Edit: Policy
L2108 2 2 Date of Service Edit: Policy
L2112 2 2 Date of Service Edit: Policy
L2114 2 2 Date of Service Edit: Policy
L2116 2 2 Date of Service Edit: Policy
L2126 2 2 Date of Service Edit: Policy
L2128 2 2 Date of Service Edit: Policy
L2132 2 2 Date of Service Edit: Policy
L2134 2 2 Date of Service Edit: Policy
L2136 2 2 Date of Service Edit: Policy
L2180 2 2 Date of Service Edit: Policy
L2182 4 2 Date of Service Edit: Policy
L2184 4 2 Date of Service Edit: Policy
L2186 4 2 Date of Service Edit: Policy
L2188 2 2 Date of Service Edit: Policy
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L2190 2 2 Date of Service Edit: Policy
L2192 2 2 Date of Service Edit: Policy
L2200 4 2 Date of Service Edit: Policy
L2210 4 2 Date of Service Edit: Policy
L2220 4 2 Date of Service Edit: Policy
L2230 2 2 Date of Service Edit: Policy
L2232 2 2 Date of Service Edit: Policy
L2240 2 2 Date of Service Edit: Policy
L2250 2 2 Date of Service Edit: Policy
L2260 2 2 Date of Service Edit: Policy
L2265 2 2 Date of Service Edit: Policy
L2270 2 3 Date of Service Edit: Clinical
L2275 2 3 Date of Service Edit: Clinical
L2280 2 2 Date of Service Edit: Policy
L2300 1 2 Date of Service Edit: Policy
L2310 1 2 Date of Service Edit: Policy
L2320 2 1 Line Edit
L2330 2 1 Line Edit
L2335 2 1 Line Edit
L2340 2 1 Line Edit
L2350 2 1 Line Edit
L2360 2 1 Line Edit
L2370 2 1 Line Edit
L2375 2 1 Line Edit
L2380 2 1 Line Edit
L2500 2 1 Line Edit
L2510 2 1 Line Edit
L2520 2 1 Line Edit
L2525 2 1 Line Edit
L2526 2 1 Line Edit
L2530 2 1 Line Edit
L2540 2 1 Line Edit
L2550 2 1 Line Edit
L2570 2 1 Line Edit
L2580 2 1 Line Edit
L2600 2 1 Line Edit
L2610 2 1 Line Edit
L2620 2 1 Line Edit
L2622 2 1 Line Edit
L2624 2 1 Line Edit
L2627 1 1 Line Edit
L2628 1 1 Line Edit
20
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L2630 1 1 Line Edit
L2640 1 1 Line Edit
L2650 2 1 Line Edit
L2660 1 1 Line Edit
L2670 2 1 Line Edit
L2680 2 1 Line Edit
L2795 2 1 Line Edit
L2800 2 1 Line Edit
L2820 2 1 Line Edit
L2830 2 1 Line Edit
L3000 2 1 Line Edit
L3001 2 1 Line Edit
L3002 2 1 Line Edit
L3003 2 1 Line Edit
L3010 2 1 Line Edit
L3020 2 1 Line Edit
L3030 2 1 Line Edit
L3031 2 1 Line Edit
L3040 2 1 Line Edit
L3050 2 1 Line Edit
L3060 2 1 Line Edit
L3070 2 1 Line Edit
L3080 2 1 Line Edit
L3090 2 1 Line Edit
L3100 2 1 Line Edit
L3140 1 1 Line Edit
L3150 1 1 Line Edit
L3160 2 1 Line Edit
L3170 2 1 Line Edit
L3215 0 3 Date of Service Edit: Clinical
L3216 0 3 Date of Service Edit: Clinical
L3217 0 3 Date of Service Edit: Clinical
L3219 0 3 Date of Service Edit: Clinical
L3221 0 3 Date of Service Edit: Clinical
L3222 0 3 Date of Service Edit: Clinical
L3224 2 1 Line Edit
L3225 2 1 Line Edit
L3230 2 1 Line Edit
L3250 2 1 Line Edit
L3251 2 1 Line Edit
L3252 2 1 Line Edit
L3253 2 1 Line Edit
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L3330 2 1 Line Edit
L3332 2 1 Line Edit
L3340 2 1 Line Edit
L3350 2 1 Line Edit
L3360 2 1 Line Edit
L3370 2 1 Line Edit
L3380 2 1 Line Edit
L3390 2 1 Line Edit
L3400 2 1 Line Edit
L3410 2 1 Line Edit
L3420 2 1 Line Edit
L3430 2 1 Line Edit
L3440 2 1 Line Edit
L3450 2 1 Line Edit
L3455 2 1 Line Edit
L3460 2 1 Line Edit
L3465 2 1 Line Edit
L3470 2 1 Line Edit
L3480 2 1 Line Edit
L3485 2 1 Line Edit
L3500 2 1 Line Edit
L3510 2 1 Line Edit
L3520 2 1 Line Edit
L3530 2 1 Line Edit
L3540 2 1 Line Edit
L3550 2 1 Line Edit
L3560 2 1 Line Edit
L3570 2 1 Line Edit
L3580 2 1 Line Edit
L3590 2 1 Line Edit
L3595 2 1 Line Edit
L3600 2 1 Line Edit
L3610 2 1 Line Edit
L3620 2 1 Line Edit
L3630 2 1 Line Edit
L3640 1 1 Line Edit
L3650 1 2 Date of Service Edit: Policy
L3660 1 2 Date of Service Edit: Policy
L3670 1 3 Date of Service Edit: Clinical
L3671 1 3 Date of Service Edit: Clinical
L3674 1 3 Date of Service Edit: Clinical
L3675 1 2 Date of Service Edit: Policy
21
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L3677 1 2 Date of Service Edit: Policy
L3678 1 2 Date of Service Edit: Policy
L3702 2 2 Date of Service Edit: Policy
L3710 2 2 Date of Service Edit: Policy
L3720 2 2 Date of Service Edit: Policy
L3730 2 2 Date of Service Edit: Policy
L3740 2 2 Date of Service Edit: Policy
L3760 2 2 Date of Service Edit: Policy
L3762 2 2 Date of Service Edit: Policy
L3763 2 2 Date of Service Edit: Policy
L3764 2 2 Date of Service Edit: Policy
L3765 2 2 Date of Service Edit: Policy
L3766 2 2 Date of Service Edit: Policy
L3806 2 2 Date of Service Edit: Policy
L3807 2 2 Date of Service Edit: Policy
L3808 2 2 Date of Service Edit: Policy
L3809 2 2 Date of Service Edit: Policy
L3900 2 2 Date of Service Edit: Policy
L3901 2 2 Date of Service Edit: Policy
L3904 2 2 Date of Service Edit: Policy
L3905 2 2 Date of Service Edit: Policy
L3906 2 2 Date of Service Edit: Policy
L3908 2 2 Date of Service Edit: Policy
L3912 2 3 Date of Service Edit: Clinical
L3913 2 2 Date of Service Edit: Policy
L3915 2 2 Date of Service Edit: Policy
L3916 2 2 Date of Service Edit: Policy
L3917 2 2 Date of Service Edit: Policy
L3918 2 2 Date of Service Edit: Policy
L3919 2 2 Date of Service Edit: Policy
L3921 2 2 Date of Service Edit: Policy
L3923 2 2 Date of Service Edit: Policy
L3924 2 2 Date of Service Edit: Policy
L3925 4 3 Date of Service Edit: Clinical
L3927 4 3 Date of Service Edit: Clinical
L3929 2 2 Date of Service Edit: Policy
L3930 2 2 Date of Service Edit: Policy
L3931 2 2 Date of Service Edit: Policy
L3933 3 3 Date of Service Edit: Clinical
L3935 3 3 Date of Service Edit: Clinical
L3960 1 3 Date of Service Edit: Clinical
L3961 1 3 Date of Service Edit: Clinical
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L3962 1 3 Date of Service Edit: Clinical
L3967 1 3 Date of Service Edit: Clinical
L3971 1 3 Date of Service Edit: Clinical
L3973 1 3 Date of Service Edit: Clinical
L3975 1 3 Date of Service Edit: Clinical
L3976 1 3 Date of Service Edit: Clinical
L3977 1 3 Date of Service Edit: Clinical
L3978 1 3 Date of Service Edit: Clinical
L3980 2 2 Date of Service Edit: Policy
L3982 2 2 Date of Service Edit: Policy
L3984 2 2 Date of Service Edit: Policy
L4000 1 1 Line Edit
L4010 2 1 Line Edit
L4020 2 1 Line Edit
L4030 2 1 Line Edit
L4040 2 1 Line Edit
L4045 2 1 Line Edit
L4050 2 1 Line Edit
L4055 2 1 Line Edit
L4060 2 1 Line Edit
L4070 2 1 Line Edit
L4080 2 1 Line Edit
L4100 2 1 Line Edit
L4130 2 1 Line Edit
L4350 2 2 Date of Service Edit: Policy
L4360 2 2 Date of Service Edit: Policy
L4361 2 2 Date of Service Edit: Policy
L4370 2 2 Date of Service Edit: Policy
L4386 2 2 Date of Service Edit: Policy
L4387 2 2 Date of Service Edit: Policy
L4392 2 1 Line Edit
L4394 2 1 Line Edit
L4396 2 2 Date of Service Edit: Policy
L4397 2 2 Date of Service Edit: Policy
L4398 2 2 Date of Service Edit: Policy
L4631 2 2 Date of Service Edit: Policy
L5000 2 3 Date of Service Edit: Clinical
L5010 2 2 Date of Service Edit: Policy
L5020 2 2 Date of Service Edit: Policy
L5050 2 2 Date of Service Edit: Policy
L5060 2 2 Date of Service Edit: Policy
L5100 2 2 Date of Service Edit: Policy
22
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L5105 2 2 Date of Service Edit: Policy
L5150 2 2 Date of Service Edit: Policy
L5160 2 2 Date of Service Edit: Policy
L5200 2 2 Date of Service Edit: Policy
L5210 2 2 Date of Service Edit: Policy
L5220 2 2 Date of Service Edit: Policy
L5230 2 2 Date of Service Edit: Policy
L5250 2 2 Date of Service Edit: Policy
L5270 2 2 Date of Service Edit: Policy
L5280 2 2 Date of Service Edit: Policy
L5301 2 2 Date of Service Edit: Policy
L5312 2 2 Date of Service Edit: Policy
L5321 2 2 Date of Service Edit: Policy
L5331 2 2 Date of Service Edit: Policy
L5341 2 2 Date of Service Edit: Policy
L5400 2 2 Date of Service Edit: Policy
L5410 2 2 Date of Service Edit: Policy
L5420 2 2 Date of Service Edit: Policy
L5430 2 2 Date of Service Edit: Policy
L5450 2 2 Date of Service Edit: Policy
L5460 2 2 Date of Service Edit: Policy
L5500 2 2 Date of Service Edit: Policy
L5505 2 2 Date of Service Edit: Policy
L5510 2 2 Date of Service Edit: Policy
L5520 2 2 Date of Service Edit: Policy
L5530 2 2 Date of Service Edit: Policy
L5535 2 2 Date of Service Edit: Policy
L5540 2 2 Date of Service Edit: Policy
L5560 2 2 Date of Service Edit: Policy
L5570 2 2 Date of Service Edit: Policy
L5580 2 2 Date of Service Edit: Policy
L5585 2 2 Date of Service Edit: Policy
L5590 2 2 Date of Service Edit: Policy
L5595 2 2 Date of Service Edit: Policy
L5600 2 2 Date of Service Edit: Policy
L5610 2 1 Line Edit
L5611 2 1 Line Edit
L5613 2 1 Line Edit
L5614 2 1 Line Edit
L5616 2 1 Line Edit
L5617 2 1 Line Edit
L5628 2 1 Line Edit
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L5629 2 1 Line Edit
L5630 2 1 Line Edit
L5631 2 1 Line Edit
L5632 2 1 Line Edit
L5634 2 1 Line Edit
L5636 2 1 Line Edit
L5637 2 1 Line Edit
L5638 2 1 Line Edit
L5639 2 1 Line Edit
L5640 2 1 Line Edit
L5642 2 1 Line Edit
L5643 2 1 Line Edit
L5644 2 1 Line Edit
L5645 2 1 Line Edit
L5646 2 1 Line Edit
L5647 2 1 Line Edit
L5648 2 1 Line Edit
L5649 2 1 Line Edit
L5650 2 1 Line Edit
L5651 2 1 Line Edit
L5652 2 1 Line Edit
L5653 2 1 Line Edit
L5654 2 1 Line Edit
L5655 2 1 Line Edit
L5656 2 1 Line Edit
L5658 2 1 Line Edit
L5661 2 1 Line Edit
L5665 2 1 Line Edit
L5666 2 1 Line Edit
L5668 2 1 Line Edit
L5670 2 1 Line Edit
L5671 2 1 Line Edit
L5672 2 1 Line Edit
L5676 2 1 Line Edit
L5677 2 1 Line Edit
L5678 2 1 Line Edit
L5680 2 1 Line Edit
L5681 2 1 Line Edit
L5682 2 1 Line Edit
L5683 2 1 Line Edit
L5684 2 1 Line Edit
L5686 2 1 Line Edit
23
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L5688 2 1 Line Edit
L5690 2 1 Line Edit
L5692 2 1 Line Edit
L5694 2 1 Line Edit
L5695 2 1 Line Edit
L5696 2 1 Line Edit
L5697 2 1 Line Edit
L5698 2 1 Line Edit
L5699 2 1 Line Edit
L5700 2 1 Line Edit
L5701 2 1 Line Edit
L5702 2 1 Line Edit
L5703 2 1 Line Edit
L5704 2 1 Line Edit
L5705 2 1 Line Edit
L5706 2 1 Line Edit
L5707 2 1 Line Edit
L5710 2 1 Line Edit
L5711 2 1 Line Edit
L5712 2 1 Line Edit
L5714 2 1 Line Edit
L5716 2 1 Line Edit
L5718 2 1 Line Edit
L5722 2 1 Line Edit
L5724 2 1 Line Edit
L5726 2 1 Line Edit
L5728 2 1 Line Edit
L5780 2 1 Line Edit
L5781 2 1 Line Edit
L5782 2 1 Line Edit
L5785 2 1 Line Edit
L5790 2 1 Line Edit
L5795 2 1 Line Edit
L5810 2 1 Line Edit
L5811 2 1 Line Edit
L5812 2 1 Line Edit
L5814 2 1 Line Edit
L5816 2 1 Line Edit
L5818 2 1 Line Edit
L5822 2 1 Line Edit
L5824 2 1 Line Edit
L5826 2 1 Line Edit
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L5828 2 1 Line Edit
L5830 2 1 Line Edit
L5840 2 1 Line Edit
L5845 2 1 Line Edit
L5848 2 1 Line Edit
L5850 2 1 Line Edit
L5855 2 1 Line Edit
L5856 2 1 Line Edit
L5857 2 1 Line Edit
L5858 2 1 Line Edit
L5859 2 1 Line Edit
L5910 2 1 Line Edit
L5920 2 1 Line Edit
L5925 2 1 Line Edit
L5930 2 1 Line Edit
L5940 2 1 Line Edit
L5950 2 1 Line Edit
L5960 2 1 Line Edit
L5961 1 1 Line Edit
L5962 2 1 Line Edit
L5964 2 1 Line Edit
L5966 2 1 Line Edit
L5968 2 1 Line Edit
L5969 0 3 Date of Service Edit: Clinical
L5970 2 1 Line Edit
L5971 2 1 Line Edit
L5972 2 1 Line Edit
L5973 2 1 Line Edit
L5974 2 1 Line Edit
L5975 2 1 Line Edit
L5976 2 1 Line Edit
L5978 2 1 Line Edit
L5979 2 1 Line Edit
L5980 2 1 Line Edit
L5981 2 1 Line Edit
L5982 2 1 Line Edit
L5984 2 1 Line Edit
L5985 2 1 Line Edit
L5986 2 1 Line Edit
L5987 2 1 Line Edit
L5988 2 1 Line Edit
L5990 2 1 Line Edit
24
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L6000 2 2 Date of Service Edit: Policy
L6010 2 2 Date of Service Edit: Policy
L6020 2 2 Date of Service Edit: Policy
L6025 2 2 Date of Service Edit: Policy
L6050 2 2 Date of Service Edit: Policy
L6055 2 2 Date of Service Edit: Policy
L6100 2 2 Date of Service Edit: Policy
L6110 2 2 Date of Service Edit: Policy
L6120 2 2 Date of Service Edit: Policy
L6130 2 2 Date of Service Edit: Policy
L6200 2 2 Date of Service Edit: Policy
L6205 2 2 Date of Service Edit: Policy
L6250 2 2 Date of Service Edit: Policy
L6300 2 2 Date of Service Edit: Policy
L6310 2 2 Date of Service Edit: Policy
L6320 2 2 Date of Service Edit: Policy
L6350 2 2 Date of Service Edit: Policy
L6360 2 2 Date of Service Edit: Policy
L6370 2 2 Date of Service Edit: Policy
L6380 2 2 Date of Service Edit: Policy
L6382 2 2 Date of Service Edit: Policy
L6384 2 2 Date of Service Edit: Policy
L6386 2 2 Date of Service Edit: Policy
L6388 2 2 Date of Service Edit: Policy
L6400 2 2 Date of Service Edit: Policy
L6450 2 2 Date of Service Edit: Policy
L6500 2 2 Date of Service Edit: Policy
L6550 2 2 Date of Service Edit: Policy
L6570 2 2 Date of Service Edit: Policy
L6580 2 2 Date of Service Edit: Policy
L6582 2 2 Date of Service Edit: Policy
L6584 2 2 Date of Service Edit: Policy
L6586 2 2 Date of Service Edit: Policy
L6588 2 2 Date of Service Edit: Policy
L6590 2 2 Date of Service Edit: Policy
L6600 2 1 Line Edit
L6605 2 1 Line Edit
L6610 2 1 Line Edit
L6611 2 1 Line Edit
L6615 2 1 Line Edit
L6616 2 1 Line Edit
L6620 2 1 Line Edit
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L6621 2 1 Line Edit
L6623 2 1 Line Edit
L6624 2 1 Line Edit
L6625 2 1 Line Edit
L6628 2 1 Line Edit
L6629 2 1 Line Edit
L6630 2 1 Line Edit
L6635 2 1 Line Edit
L6637 2 1 Line Edit
L6638 2 1 Line Edit
L6640 2 1 Line Edit
L6641 2 1 Line Edit
L6642 2 1 Line Edit
L6645 2 1 Line Edit
L6646 2 1 Line Edit
L6647 2 1 Line Edit
L6648 2 1 Line Edit
L6650 2 1 Line Edit
L6670 2 1 Line Edit
L6672 2 1 Line Edit
L6675 2 1 Line Edit
L6676 2 1 Line Edit
L6677 2 1 Line Edit
L6686 2 1 Line Edit
L6687 2 1 Line Edit
L6688 2 1 Line Edit
L6689 2 1 Line Edit
L6690 2 1 Line Edit
L6693 2 1 Line Edit
L6694 2 1 Line Edit
L6695 2 1 Line Edit
L6696 2 1 Line Edit
L6697 2 1 Line Edit
L6698 2 1 Line Edit
L6703 2 1 Line Edit
L6704 2 1 Line Edit
L6706 2 1 Line Edit
L6707 2 1 Line Edit
L6708 2 1 Line Edit
L6709 2 1 Line Edit
L6711 2 1 Line Edit
L6712 2 1 Line Edit
25
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L6713 2 1 Line Edit
L6714 2 1 Line Edit
L6715 4 3 Date of Service Edit: Clinical
L6721 2 1 Line Edit
L6722 2 1 Line Edit
L6805 2 1 Line Edit
L6810 2 1 Line Edit
L6880 2 1 Line Edit
L6881 2 1 Line Edit
L6882 2 1 Line Edit
L6883 2 1 Line Edit
L6884 2 1 Line Edit
L6885 2 1 Line Edit
L6890 2 1 Line Edit
L6895 2 1 Line Edit
L6900 2 1 Line Edit
L6905 2 1 Line Edit
L6910 2 1 Line Edit
L6915 2 1 Line Edit
L6920 2 2 Date of Service Edit: Policy
L6925 2 2 Date of Service Edit: Policy
L6930 2 2 Date of Service Edit: Policy
L6935 2 2 Date of Service Edit: Policy
L6940 2 2 Date of Service Edit: Policy
L6945 2 2 Date of Service Edit: Policy
L6950 2 2 Date of Service Edit: Policy
L6955 2 2 Date of Service Edit: Policy
L6960 2 2 Date of Service Edit: Policy
L6965 2 2 Date of Service Edit: Policy
L6970 2 2 Date of Service Edit: Policy
L6975 2 2 Date of Service Edit: Policy
L7007 2 1 Line Edit
L7008 2 1 Line Edit
L7009 2 1 Line Edit
L7040 2 1 Line Edit
L7045 2 1 Line Edit
L7170 2 1 Line Edit
L7180 2 1 Line Edit
L7181 2 1 Line Edit
L7185 2 1 Line Edit
L7186 2 1 Line Edit
L7190 2 1 Line Edit
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L7191 2 1 Line Edit
L7260 2 1 Line Edit
L7261 2 1 Line Edit
L7362 1 1 Line Edit
L7366 1 1 Line Edit
L7368 1 1 Line Edit
L7400 2 1 Line Edit
L7401 2 1 Line Edit
L7402 2 1 Line Edit
L7403 2 1 Line Edit
L7404 2 1 Line Edit
L7405 2 1 Line Edit
L7900 1 1 Line Edit
L7902 1 1 Line Edit
L8030 2 1 Line Edit
L8031 2 1 Line Edit
L8032 2 1 Line Edit
L8035 2 1 Line Edit
L8039 2 1 Line Edit
L8040 1 1 Line Edit
L8041 1 1 Line Edit
L8042 2 1 Line Edit
L8043 1 1 Line Edit
L8044 1 1 Line Edit
L8045 2 1 Line Edit
L8046 1 1 Line Edit
L8047 1 1 Line Edit
L8048 1 3 Date of Service Edit: Clinical
L8300 1 1 Line Edit
L8310 1 1 Line Edit
L8320 2 1 Line Edit
L8330 2 1 Line Edit
L8500 1 1 Line Edit
L8501 2 1 Line Edit
L8507 3 1 Line Edit
L8509 1 1 Line Edit
L8510 1 1 Line Edit
L8511 1 1 Line Edit
L8514 1 1 Line Edit
L8515 1 1 Line Edit
L8600 2 1 Line Edit
L8604 3 1 Line Edit
26
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
L8605 4 3 Date of Service Edit: Clinical
L8606 5 3 Date of Service Edit: Clinical
L8609 1 1 Line Edit
L8610 2 1 Line Edit
L8612 2 1 Line Edit
L8613 2 1 Line Edit
L8614 2 1 Line Edit
L8615 2 1 Line Edit
L8616 2 1 Line Edit
L8617 2 1 Line Edit
L8618 2 1 Line Edit
L8619 2 1 Line Edit
L8621 600 3 Date of Service Edit: Clinical
L8622 2 1 Line Edit
L8627 2 2 Date of Service Edit: Policy
L8628 2 2 Date of Service Edit: Policy
L8629 2 2 Date of Service Edit: Policy
L8631 4 1 Line Edit
L8641 4 1 Line Edit
L8642 2 1 Line Edit
L8658 4 1 Line Edit
L8659 4 1 Line Edit
L8670 4 1 Line Edit
L8679 3 3 Date of Service Edit: Clinical
L8681 1 1 Line Edit
L8682 2 1 Line Edit
L8683 1 1 Line Edit
L8684 1 1 Line Edit
L8685 1 1 Line Edit
L8686 2 1 Line Edit
L8687 1 1 Line Edit
L8688 1 1 Line Edit
L8689 1 1 Line Edit
L8690 2 2 Date of Service Edit: Policy
L8691 1 3 Date of Service Edit: Clinical
L8692 0 3 Date of Service Edit: Clinical
L8693 1 3 Date of Service Edit: Clinical
L8695 1 1 Line Edit
M0064 1 2 Date of Service Edit: Policy
P2028 1 1 Line Edit
P2029 1 1 Line Edit
P2033 1 1 Line Edit
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
P2038 1 1 Line Edit
P3000 1 3 Date of Service Edit: Clinical
P3001 1 3 Date of Service Edit: Clinical
P9041 100 3 Date of Service Edit: Clinical
P9043 10 3 Date of Service Edit: Clinical
P9045 20 3 Date of Service Edit: Clinical
P9046 40 3 Date of Service Edit: Clinical
P9047 20 3 Date of Service Edit: Clinical
P9048 2 3 Date of Service Edit: Clinical
P9612 1 3 Date of Service Edit: Clinical
P9615 1 3 Date of Service Edit: Clinical
Q0035 1 1 Line Edit
Q0085 2 1 Line Edit
Q0091 1 1 Line Edit
Q0111 2 1 Line Edit
Q0112 3 1 Line Edit
Q0113 2 1 Line Edit
Q0114 1 1 Line Edit
Q0115 1 1 Line Edit
Q0144 0 3 Date of Service Edit: Clinical
Q0161 30 3 Date of Service Edit: Clinical
Q0478 1 1 Line Edit
Q0479 1 1 Line Edit
Q0480 1 1 Line Edit
Q0481 1 2 Date of Service Edit: Policy
Q0482 1 1 Line Edit
Q0483 1 1 Line Edit
Q0484 1 1 Line Edit
Q0485 1 1 Line Edit
Q0486 1 1 Line Edit
Q0487 1 1 Line Edit
Q0488 1 1 Line Edit
Q0489 1 1 Line Edit
Q0490 1 1 Line Edit
Q0491 1 1 Line Edit
Q0492 1 1 Line Edit
Q0493 1 1 Line Edit
Q0494 1 1 Line Edit
Q0495 1 1 Line Edit
Q0497 2 1 Line Edit
Q0498 1 1 Line Edit
Q0499 1 1 Line Edit
27
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
Q4105 250 3 Date of Service Edit: Clinical
Q4106 152 3 Date of Service Edit: Clinical
Q4107 128 3 Date of Service Edit: Clinical
Q4108 250 3 Date of Service Edit: Clinical
Q4110 250 3 Date of Service Edit: Clinical
Q4111 112 3 Date of Service Edit: Clinical
Q4112 2 3 Date of Service Edit: Clinical
Q4113 4 3 Date of Service Edit: Clinical
Q4114 6 3 Date of Service Edit: Clinical
Q4115 240 3 Date of Service Edit: Clinical
Q4116 320 3 Date of Service Edit: Clinical
Q4117 0 3 Date of Service Edit: Clinical
Q4118 1000 3 Date of Service Edit: Clinical
Q4119 300 3 Date of Service Edit: Clinical
Q4120 0 3 Date of Service Edit: Clinical
Q4121 156 3 Date of Service Edit: Clinical
Q4122 96 3 Date of Service Edit: Clinical
Q4123 160 3 Date of Service Edit: Clinical
Q4124 280 3 Date of Service Edit: Clinical
Q4125 28 3 Date of Service Edit: Clinical
Q4126 0 3 Date of Service Edit: Clinical
Q4127 100 3 Date of Service Edit: Clinical
Q4128 128 3 Date of Service Edit: Clinical
Q4129 81 3 Date of Service Edit: Clinical
Q4130 100 3 Date of Service Edit: Clinical
Q4131 49 3 Date of Service Edit: Clinical
Q4132 50 3 Date of Service Edit: Clinical
Q4133 113 3 Date of Service Edit: Clinical
Q4134 160 3 Date of Service Edit: Clinical
Q4135 900 3 Date of Service Edit: Clinical
Q4136 900 3 Date of Service Edit: Clinical
Q9955 10 2 Date of Service Edit: Policy
R0070 2 1 Line Edit
R0075 2 1 Line Edit
R0076 1 1 Line Edit
V2020 1 1 Line Edit
V2101 2 1 Line Edit
V2102 2 1 Line Edit
V2104 2 1 Line Edit
V2105 2 1 Line Edit
V2106 2 1 Line Edit
V2107 2 1 Line Edit
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
Q0501 1 1 Line Edit
Q0502 1 1 Line Edit
Q0503 3 1 Line Edit
Q0504 1 1 Line Edit
Q0507 1 3 Date of Service Edit: Clinical
Q0508 1 3 Date of Service Edit: Clinical
Q0509 1 3 Date of Service Edit: Clinical
Q0510 1 2 Date of Service Edit: Policy
Q0511 1 2 Date of Service Edit: Policy
Q0512 4 3 Date of Service Edit: Clinical
Q0513 1 2 Date of Service Edit: Policy
Q0514 1 2 Date of Service Edit: Policy
Q1004 2 1 Line Edit
Q1005 2 1 Line Edit
Q2004 1 3 Date of Service Edit: Clinical
Q2028 1470 3 Date of Service Edit: Clinical
Q2034 1 1 Line Edit
Q2035 1 2 Date of Service Edit: Policy
Q2036 1 2 Date of Service Edit: Policy
Q2037 1 2 Date of Service Edit: Policy
Q2038 1 2 Date of Service Edit: Policy
Q2039 1 2 Date of Service Edit: Policy
Q2043 1 1 Line Edit
Q2050 20 3 Date of Service Edit: Clinical
Q2052 1 3 Date of Service Edit: Clinical
Q3014 2 3 Date of Service Edit: Clinical
Q3027 30 3 Date of Service Edit: Clinical
Q3028 0 3 Date of Service Edit: Clinical
Q3031 1 1 Line Edit
Q4001 1 1 Line Edit
Q4002 1 1 Line Edit
Q4003 2 1 Line Edit
Q4004 2 1 Line Edit
Q4025 1 1 Line Edit
Q4026 1 1 Line Edit
Q4027 1 1 Line Edit
Q4028 1 1 Line Edit
Q4074 0 3 Date of Service Edit: Clinical
Q4101 176 3 Date of Service Edit: Clinical
Q4102 140 3 Date of Service Edit: Clinical
Q4103 0 3 Date of Service Edit: Clinical
Q4104 250 3 Date of Service Edit: Clinical
28
FACILITY OUTPATIENT SERVICES EDITS2015 H
OSPITA
L OU
TPATIEN
T MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
V2108 2 1 Line Edit
V2109 2 1 Line Edit
V2110 2 1 Line Edit
V2111 2 1 Line Edit
V2112 2 1 Line Edit
V2113 2 1 Line Edit
V2114 2 1 Line Edit
V2115 2 1 Line Edit
V2118 2 1 Line Edit
V2121 2 1 Line Edit
V2199 2 3 Date of Service Edit: Clinical
V2200 2 1 Line Edit
V2201 2 1 Line Edit
V2202 2 1 Line Edit
V2203 2 1 Line Edit
V2204 2 1 Line Edit
V2205 2 1 Line Edit
V2206 2 1 Line Edit
V2207 2 1 Line Edit
V2208 2 1 Line Edit
V2209 2 1 Line Edit
V2210 2 1 Line Edit
V2211 2 1 Line Edit
V2212 2 1 Line Edit
V2213 2 1 Line Edit
V2214 2 1 Line Edit
V2215 2 1 Line Edit
V2218 2 1 Line Edit
V2219 2 1 Line Edit
V2220 2 1 Line Edit
V2221 2 1 Line Edit
V2299 2 1 Line Edit
V2300 2 1 Line Edit
V2301 2 1 Line Edit
V2302 2 1 Line Edit
V2303 2 1 Line Edit
V2304 2 1 Line Edit
V2305 2 1 Line Edit
V2306 2 1 Line Edit
V2307 2 1 Line Edit
V2308 2 1 Line Edit
V2309 2 1 Line Edit
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
V2310 2 1 Line Edit
V2311 2 1 Line Edit
V2312 2 1 Line Edit
V2313 2 1 Line Edit
V2314 2 1 Line Edit
V2315 2 1 Line Edit
V2318 2 1 Line Edit
V2319 2 1 Line Edit
V2320 2 1 Line Edit
V2321 2 1 Line Edit
V2399 2 1 Line Edit
V2410 2 1 Line Edit
V2430 2 1 Line Edit
V2499 2 3 Date of Service Edit: Clinical
V2500 2 1 Line Edit
V2501 2 1 Line Edit
V2502 2 1 Line Edit
V2503 2 1 Line Edit
V2510 2 1 Line Edit
V2511 2 1 Line Edit
V2512 2 1 Line Edit
V2513 2 1 Line Edit
V2520 2 1 Line Edit
V2521 2 1 Line Edit
V2522 2 1 Line Edit
V2523 2 1 Line Edit
V2530 2 1 Line Edit
V2531 2 1 Line Edit
V2599 2 3 Date of Service Edit: Clinical
V2600 1 1 Line Edit
V2610 1 1 Line Edit
V2615 2 1 Line Edit
V2623 2 1 Line Edit
V2624 2 1 Line Edit
V2625 2 1 Line Edit
V2626 2 1 Line Edit
V2627 2 1 Line Edit
V2628 2 1 Line Edit
V2629 2 1 Line Edit
V2630 2 1 Line Edit
V2631 2 1 Line Edit
V2632 2 1 Line Edit
29
2015 HCPCS: LEVEL II NATIONAL CODES20
15 H
OSP
ITA
L O
UTP
ATI
ENT
MU
E
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
V2700 2 1 Line Edit
V2710 2 1 Line Edit
V2718 2 1 Line Edit
V2730 2 1 Line Edit
V2761 2 1 Line Edit
V2770 2 1 Line Edit
V2780 2 1 Line Edit
V2781 2 1 Line Edit
V2782 2 1 Line Edit
V2783 2 1 Line Edit
V2785 2 1 Line Edit
V2790 1 1 Line Edit
V2797 1 1 Line Edit
V5008 0 1 Line Edit
HCPCS/CPT Code
Outpatient Hospital
Services MUE Values
MUE Adjudication Indicator
V5010 0 1 Line Edit
V5011 0 1 Line Edit
V5274 0 3 Date of Service Edit: Clinical
V5281 0 1 Line Edit
V5282 0 1 Line Edit
V5284 0 1 Line Edit
V5285 0 1 Line Edit
V5286 0 1 Line Edit
V5287 0 1 Line Edit
V5288 0 1 Line Edit
V5289 0 1 Line Edit