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2017 HCPCS: LEVEL II NATIONAL CODES20

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2016 Practitioners/DME Suppliers Medically Unlikely Edits (MUEs)

Practitioner Edits(Effective Date: 10/01/2016-12/31/2016, Version: 22.3)

This fi le contains two sets of edits that provide guidance when reporting physician/provider services/procedures/supplies/equipment with HCPCS codes.

1. Practitioner/DME Supplier Medically Unlikely Edits (MUEs) 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.

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorA0021 0 3 Date of Service Edit: Clinical

A0080 0 3 Date of Service Edit: Clinical

A0090 0 3 Date of Service Edit: Clinical

A0100 0 3 Date of Service Edit: Clinical

A0110 0 3 Date of Service Edit: Clinical

A0120 0 3 Date of Service Edit: Clinical

A0130 0 3 Date of Service Edit: Clinical

A0140 0 3 Date of Service Edit: Clinical

A0160 0 3 Date of Service Edit: Clinical

A0170 0 3 Date of Service Edit: Clinical

A0180 0 3 Date of Service Edit: Clinical

A0190 0 3 Date of Service Edit: Clinical

A0200 0 3 Date of Service Edit: Clinical

A0210 0 3 Date of Service Edit: Clinical

A0225 0 3 Date of Service Edit: Clinical

A0380 0 3 Date of Service Edit: Clinical

A0382 0 3 Date of Service Edit: Clinical

A0384 0 3 Date of Service Edit: Clinical

A0390 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

A0425 250 1 Line Edit

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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorA0432 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

A0888 0 3 Date of Service Edit: Clinical

A0998 0 3 Date of Service Edit: Clinical

A4221 0 3 Date of Service Edit: Clinical

A4235 2 1 Line Edit

A4253 0 3 Date of Service Edit: Clinical

A4255 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

A4301 1 2 Date of Service Edit: Policy

A4337 0 3 Date of Service Edit: Clinical

A4356 1 1 Line Edit

A4459 0 3 Date of Service Edit: Clinical

A4470 1 1 Line Edit

A4480 1 1 Line Edit

A4555 0 3 Date of Service Edit: Clinical

A4557 2 1 Line Edit

A4561 1 1 Line Edit

A4562 1 1 Line Edit

A4565 2 3 Date of Service Edit: Clinical

A4602 0 3 Date of Service Edit: Clinical

A4606 0 3 Date of Service Edit: Clinical

A4611 0 3 Date of Service Edit: Clinical

A4614 1 1 Line Edit

A4625 30 3 Date of Service Edit: Clinical

A4633 0 3 Date of Service Edit: Clinical

A4635 0 3 Date of Service Edit: Clinical

A4638 0 3 Date of Service Edit: Clinical

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HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorA4640 0 3 Date of Service Edit: Clinical

A4642 1 3 Date of Service Edit: Clinical

A4648 5 3 Date of Service Edit: Clinical

A4650 3 1 Line Edit

A5056 90 3 Date of Service Edit: Clinical

A5057 90 3 Date of Service Edit: Clinical

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 0 3 Date of Service Edit: Clinical

A6531 0 3 Date of Service Edit: Clinical

A6532 0 3 Date of Service Edit: Clinical

A6545 0 3 Date of Service Edit: Clinical

A7000 0 3 Date of Service Edit: Clinical

A7003 0 3 Date of Service Edit: Clinical

A7005 0 3 Date of Service Edit: Clinical

A7006 0 3 Date of Service Edit: Clinical

A7013 0 3 Date of Service Edit: Clinical

A7014 0 3 Date of Service Edit: Clinical

A7016 0 3 Date of Service Edit: Clinical

A7017 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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorA7027 0 3 Date of Service Edit: Clinical

A7028 0 3 Date of Service Edit: Clinical

A7029 0 3 Date of Service Edit: Clinical

A7032 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

A7039 0 3 Date of Service Edit: Clinical

A7040 2 1 Line Edit

A7041 2 1 Line Edit

A7044 0 3 Date of Service Edit: Clinical

A7047 0 3 Date of Service Edit: Clinical

A7048 10 3 Date of Service Edit: Clinical

A7501 0 3 Date of Service Edit: Clinical

A7504 0 3 Date of Service Edit: Clinical

A7507 0 3 Date of Service Edit: Clinical

A7520 0 3 Date of Service Edit: Clinical

A7524 0 3 Date of Service Edit: Clinical

A7527 0 3 Date of Service Edit: Clinical

A9272 0 1 Line Edit

A9284 0 3 Date of Service Edit: Clinical

A9500 3 3 Date of Service Edit: Clinical

A9501 1 3 Date of Service Edit: Clinical

A9502 3 3 Date of Service Edit: Clinical

A9503 1 3 Date of Service Edit: Clinical

A9504 1 3 Date of Service Edit: Clinical

A9505 4 3 Date of Service Edit: Clinical

A9507 1 3 Date of Service Edit: Clinical

A9508 2 3 Date of Service Edit: Clinical

A9509 5 3 Date of Service Edit: Clinical

A9510 1 3 Date of Service Edit: Clinical

A9512 30 3 Date of Service Edit: Clinical

A9516 4 3 Date of Service Edit: Clinical

A9517 200 3 Date of Service Edit: Clinical

A9520 1 3 Date of Service Edit: Clinical

A9521 2 3 Date of Service Edit: Clinical

A9524 10 3 Date of Service Edit: Clinical

A9526 2 3 Date of Service Edit: Clinical

A9527 195 3 Date of Service Edit: Clinical

A9528 10 3 Date of Service Edit: Clinical

A9529 10 3 Date of Service Edit: Clinical

A9530 200 3 Date of Service Edit: Clinical

A9531 100 3 Date of Service Edit: Clinical

A9532 10 3 Date of Service Edit: Clinical

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HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorA9536 1 3 Date of Service Edit: Clinical

A9537 1 3 Date of Service Edit: Clinical

A9538 1 3 Date of Service Edit: Clinical

A9539 2 3 Date of Service Edit: Clinical

A9540 2 3 Date of Service Edit: Clinical

A9541 1 3 Date of Service Edit: Clinical

A9542 1 3 Date of Service Edit: Clinical

A9543 1 3 Date of Service Edit: Clinical

A9544 1 3 Date of Service Edit: Clinical

A9545 1 3 Date of Service Edit: Clinical

A9546 1 3 Date of Service Edit: Clinical

A9547 2 3 Date of Service Edit: Clinical

A9548 2 3 Date of Service Edit: Clinical

A9550 1 3 Date of Service Edit: Clinical

A9551 1 3 Date of Service Edit: Clinical

A9552 1 3 Date of Service Edit: Clinical

A9553 1 3 Date of Service Edit: Clinical

A9554 1 3 Date of Service Edit: Clinical

A9555 2 3 Date of Service Edit: Clinical

A9556 10 3 Date of Service Edit: Clinical

A9557 2 3 Date of Service Edit: Clinical

A9558 7 3 Date of Service Edit: Clinical

A9559 1 1 Line Edit

A9560 2 3 Date of Service Edit: Clinical

A9561 1 3 Date of Service Edit: Clinical

A9562 2 3 Date of Service Edit: Clinical

A9563 10 3 Date of Service Edit: Clinical

A9564 20 3 Date of Service Edit: Clinical

A9566 1 3 Date of Service Edit: Clinical

A9567 2 3 Date of Service Edit: Clinical

A9568 0 3 Date of Service Edit: Clinical

A9569 1 3 Date of Service Edit: Clinical

A9570 1 3 Date of Service Edit: Clinical

A9571 1 3 Date of Service Edit: Clinical

A9572 1 3 Date of Service Edit: Clinical

A9575 200 3 Date of Service Edit: Clinical

A9576 40 3 Date of Service Edit: Clinical

A9577 50 3 Date of Service Edit: Clinical

A9578 50 3 Date of Service Edit: Clinical

A9579 100 3 Date of Service Edit: Clinical

A9580 1 3 Date of Service Edit: Clinical

A9581 20 3 Date of Service Edit: Clinical

A9582 1 3 Date of Service Edit: Clinical

A9583 18 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorA9584 1 3 Date of Service Edit: Clinical

A9585 300 3 Date of Service Edit: Clinical

A9586 1 3 Date of Service Edit: Clinical

A9599 1 3 Date of Service Edit: Clinical

A9600 7 3 Date of Service Edit: Clinical

A9604 1 3 Date of Service Edit: Clinical

A9606 203 3 Date of Service Edit: Clinical

A9700 2 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 0 3 Date of Service Edit: Clinical

B4088 0 3 Date of Service Edit: Clinical

B4149 0 3 Date of Service Edit: Clinical

B4153 0 3 Date of Service Edit: Clinical

B4157 0 3 Date of Service Edit: Clinical

B4160 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

B4199 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

C1716 4 3 Date of Service Edit: Clinical

C1717 10 3 Date of Service Edit: Clinical

C1719 99 3 Date of Service Edit: Clinical

C1721 1 3 Date of Service Edit: Clinical

C1722 1 3 Date of Service Edit: Clinical

C1749 1 3 Date of Service Edit: Clinical

C1764 1 3 Date of Service Edit: Clinical

C1767 2 3 Date of Service Edit: Clinical

C1771 1 3 Date of Service Edit: Clinical

C1772 1 3 Date of Service Edit: Clinical

C1776 10 3 Date of Service Edit: Clinical

C1778 4 3 Date of Service Edit: Clinical

C1782 1 3 Date of Service Edit: Clinical

C1785 1 3 Date of Service Edit: Clinical

C1786 1 3 Date of Service Edit: Clinical

C1813 1 3 Date of Service Edit: Clinical

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HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorC1815 1 3 Date of Service Edit: Clinical

C1817 1 3 Date of Service Edit: Clinical

C1820 2 3 Date of Service Edit: Clinical

C1822 1 3 Date of Service Edit: Clinical

C1830 2 3 Date of Service Edit: Clinical

C1840 1 3 Date of Service Edit: Clinical

C1841 1 3 Date of Service Edit: Clinical

C1882 1 3 Date of Service Edit: Clinical

C1886 1 3 Date of Service Edit: Clinical

C1900 1 3 Date of Service Edit: Clinical

C2613 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

C2623 3 1 Line Edit

C2624 1 3 Date of Service Edit: Clinical

C2626 1 3 Date of Service Edit: Clinical

C2631 1 3 Date of Service Edit: Clinical

C2634 24 3 Date of Service Edit: Clinical

C2635 124 3 Date of Service Edit: Clinical

C2636 600 3 Date of Service Edit: Clinical

C2637 0 3 Date of Service Edit: Clinical

C2638 150 3 Date of Service Edit: Clinical

C2639 150 3 Date of Service Edit: Clinical

C2640 150 3 Date of Service Edit: Clinical

C2641 150 3 Date of Service Edit: Clinical

C2642 120 3 Date of Service Edit: Clinical

C2643 120 3 Date of Service Edit: Clinical

C2644 500 1 Line Edit

C2645 6912 1 Line Edit

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

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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorC8904 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

C8957 2 3 Date of Service Edit: Clinical

C9113 0 3 Date of Service Edit: Clinical

C9121 0 3 Date of Service Edit: Clinical

C9132 5500 3 Date of Service Edit: Clinical

C9248 0 3 Date of Service Edit: Clinical

C9250 1 3 Date of Service Edit: Clinical

C9254 0 3 Date of Service Edit: Clinical

C9257 5 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

C9349 54 1 Line Edit

C9352 3 3 Date of Service Edit: Clinical

C9353 4 3 Date of Service Edit: Clinical

C9354 300 3 Date of Service Edit: Clinical

C9355 3 3 Date of Service Edit: Clinical

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2017 HCPCS: LEVEL II NATIONAL CODES20

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HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorC9356 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

C9447 1 3 Date of Service Edit: Clinical

C9460 100 1 Line Edit

C9497 1 3 Date of Service Edit: Clinical

C9600 3 3 Date of Service Edit: Clinical

C9601 2 3 Date of Service Edit: Clinical

C9602 2 3 Date of Service Edit: Clinical

C9603 2 3 Date of Service Edit: Clinical

C9604 2 3 Date of Service Edit: Clinical

C9605 2 3 Date of Service Edit: Clinical

C9606 1 3 Date of Service Edit: Clinical

C9607 1 2 Date of Service Edit: Policy

C9608 2 3 Date of Service Edit: Clinical

C9725 1 3 Date of Service Edit: Clinical

C9727 1 2 Date of Service Edit: Policy

C9728 1 2 Date of Service Edit: Policy

C9733 1 3 Date of Service Edit: Clinical

C9734 1 3 Date of Service Edit: Clinical

C9739 1 2 Date of Service Edit: Policy

C9740 1 2 Date of Service Edit: Policy

C9741 1 3 Date of Service Edit: Clinical

C9742 1 2 Date of Service Edit: Policy

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

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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE0144 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 2 2 Date of Service Edit: Policy

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

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

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HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE0217 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

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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE0300 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

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

E0445 0 3 Date of Service Edit: Clinical

E0446 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

E0462 0 3 Date of Service Edit: Clinical

E0465 0 3 Date of Service Edit: Clinical

E0466 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

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HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE0482 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

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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE0639 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

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 0 3 Date of Service Edit: Clinical

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 0 3 Date of Service Edit: Clinical

E0764 0 3 Date of Service Edit: Clinical

8

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE0765 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 1 2 Date of Service Edit: Policy

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

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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE0956 0 3 Date of Service Edit: Clinical

E0957 0 3 Date of Service Edit: Clinical

E0958 0 3 Date of Service Edit: Clinical

E0959 0 3 Date of Service Edit: Clinical

E0960 0 3 Date of Service Edit: Clinical

E0961 0 3 Date of Service Edit: Clinical

E0966 0 3 Date of Service Edit: Clinical

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 0 3 Date of Service Edit: Clinical

E0973 0 3 Date of Service Edit: Clinical

E0974 0 3 Date of Service Edit: Clinical

E0978 0 3 Date of Service Edit: Clinical

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

E0988 0 3 Date of Service Edit: Clinical

E0990 0 3 Date of Service Edit: Clinical

E0992 0 3 Date of Service Edit: Clinical

E0994 0 3 Date of Service Edit: Clinical

E0995 0 3 Date of Service Edit: Clinical

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

E1012 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

9

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE1030 0 3 Date of Service Edit: Clinical

E1031 0 3 Date of Service Edit: Clinical

E1035 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

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 0 3 Date of Service Edit: Clinical

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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE1232 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

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

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

10

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE1610 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

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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE2208 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

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

11

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE2341 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

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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorE2511 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

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 1 3 Date of Service Edit: Clinical

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

G0108 6 3 Date of Service Edit: Clinical

12

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorG0109 12 3 Date of Service Edit: Clinical

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

G0127 1 2 Date of Service Edit: Policy

G0128 1 3 Date of Service Edit: Clinical

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 3 Date of Service Edit: Clinical

G0168 2 3 Date of Service Edit: Clinical

G0175 1 3 Date of Service Edit: Clinical

G0177 0 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

G0237 8 3 Date of Service Edit: Clinical

G0238 8 3 Date of Service Edit: Clinical

G0239 1 3 Date of Service Edit: Clinical

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 3 Date of Service Edit: Clinical

G0250 1 2 Date of Service Edit: Policy

G0257 0 3 Date of Service Edit: Clinical

G0259 2 3 Date of Service Edit: Clinical

G0260 2 3 Date of Service Edit: Clinical

G0268 1 2 Date of Service Edit: Policy

G0270 8 3 Date of Service Edit: Clinical

G0271 4 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorG0277 5 3 Date of Service Edit: Clinical

G0278 1 2 Date of Service Edit: Policy

G0281 1 3 Date of Service Edit: Clinical

G0283 1 3 Date of Service Edit: Clinical

G0288 1 2 Date of Service Edit: Policy

G0289 1 2 Date of Service Edit: Policy

G0293 1 2 Date of Service Edit: Policy

G0294 1 2 Date of Service Edit: Policy

G0296 1 2 Date of Service Edit: Policy

G0297 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 1 3 Date of Service Edit: Clinical

G0307 1 3 Date of Service Edit: Clinical

G0328 1 2 Date of Service Edit: Policy

G0329 1 3 Date of Service Edit: Clinical

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 3 Date of Service Edit: Clinical

G0365 2 3 Date of Service Edit: Clinical

G0372 1 2 Date of Service Edit: Policy

G0379 0 3 Date of Service Edit: Clinical

G0389 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

G0406 1 3 Date of Service Edit: Clinical

G0407 1 3 Date of Service Edit: Clinical

G0408 1 3 Date of Service Edit: Clinical

G0410 1 3 Date of Service Edit: Clinical

G0411 1 3 Date of Service Edit: Clinical

13

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorG0412 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

G0420 2 3 Date of Service Edit: Clinical

G0421 4 3 Date of Service Edit: Clinical

G0422 6 2 Date of Service Edit: Policy

G0423 6 2 Date of Service Edit: Policy

G0424 2 2 Date of Service Edit: Policy

G0425 1 3 Date of Service Edit: Clinical

G0426 1 3 Date of Service Edit: Clinical

G0427 1 3 Date of Service Edit: Clinical

G0429 1 2 Date of Service Edit: Policy

G0432 1 2 Date of Service Edit: Policy

G0433 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

G0446 1 3 Date of Service Edit: Clinical

G0448 1 3 Date of Service Edit: Clinical

G0452 6 3 Date of Service Edit: Clinical

G0453 40 3 Date of Service Edit: Clinical

G0454 1 2 Date of Service Edit: Policy

G0455 1 2 Date of Service Edit: Policy

G0458 1 3 Date of Service Edit: Clinical

G0459 1 3 Date of Service Edit: Clinical

G0460 1 3 Date of Service Edit: Clinical

G0463 0 3 Date of Service Edit: Clinical

G0472 1 2 Date of Service Edit: Policy

G0475 1 2 Date of Service Edit: Policy

G0476 1 2 Date of Service Edit: Policy

G0477 1 2 Date of Service Edit: Policy

G0478 1 2 Date of Service Edit: Policy

G0479 1 2 Date of Service Edit: Policy

G0480 1 2 Date of Service Edit: Policy

G0481 1 2 Date of Service Edit: Policy

G0482 1 2 Date of Service Edit: Policy

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorG0483 1 2 Date of Service Edit: Policy

G3001 1 2 Date of Service Edit: Policy

G6001 1 2 Date of Service Edit: Policy

G6002 2 3 Date of Service Edit: Clinical

G6003 2 3 Date of Service Edit: Clinical

G6004 2 3 Date of Service Edit: Clinical

G6005 2 3 Date of Service Edit: Clinical

G6006 2 3 Date of Service Edit: Clinical

G6007 2 3 Date of Service Edit: Clinical

G6008 2 3 Date of Service Edit: Clinical

G6009 2 3 Date of Service Edit: Clinical

G6010 2 3 Date of Service Edit: Clinical

G6011 2 3 Date of Service Edit: Clinical

G6012 2 3 Date of Service Edit: Clinical

G6013 2 3 Date of Service Edit: Clinical

G6014 2 3 Date of Service Edit: Clinical

G6015 2 3 Date of Service Edit: Clinical

G6016 2 3 Date of Service Edit: Clinical

G6017 2 3 Date of Service Edit: Clinical

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 1 3 Date of Service Edit: Clinical

G9480 1 3 Date of Service Edit: Clinical

J0120 1 3 Date of Service Edit: Clinical

J0129 100 3 Date of Service Edit: Clinical

J0130 6 3 Date of Service Edit: Clinical

J0131 400 3 Date of Service Edit: Clinical

J0132 12 3 Date of Service Edit: Clinical

J0133 1200 3 Date of Service Edit: Clinical

J0135 8 3 Date of Service Edit: Clinical

J0153 180 3 Date of Service Edit: Clinical

J0171 20 3 Date of Service Edit: Clinical

J0178 4 3 Date of Service Edit: Clinical

J0180 150 3 Date of Service Edit: Clinical

J0190 0 3 Date of Service Edit: Clinical

J0200 0 3 Date of Service Edit: Clinical

J0202 12 3 Date of Service Edit: Clinical

J0205 0 3 Date of Service Edit: Clinical

J0207 4 3 Date of Service Edit: Clinical

J0210 4 3 Date of Service Edit: Clinical

J0215 30 3 Date of Service Edit: Clinical

J0220 1 3 Date of Service Edit: Clinical

J0221 300 3 Date of Service Edit: Clinical

14

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ0256 3500 3 Date of Service Edit: Clinical

J0257 1400 3 Date of Service Edit: Clinical

J0270 32 3 Date of Service Edit: Clinical

J0275 1 3 Date of Service Edit: Clinical

J0278 15 3 Date of Service Edit: Clinical

J0280 7 3 Date of Service Edit: Clinical

J0282 5 3 Date of Service Edit: Clinical

J0285 5 3 Date of Service Edit: Clinical

J0287 20 3 Date of Service Edit: Clinical

J0288 0 3 Date of Service Edit: Clinical

J0289 50 3 Date of Service Edit: Clinical

J0290 24 3 Date of Service Edit: Clinical

J0295 12 3 Date of Service Edit: Clinical

J0300 8 3 Date of Service Edit: Clinical

J0330 10 3 Date of Service Edit: Clinical

J0348 200 3 Date of Service Edit: Clinical

J0350 0 3 Date of Service Edit: Clinical

J0360 2 3 Date of Service Edit: Clinical

J0364 6 3 Date of Service Edit: Clinical

J0365 0 3 Date of Service Edit: Clinical

J0380 1 3 Date of Service Edit: Clinical

J0390 0 3 Date of Service Edit: Clinical

J0395 0 3 Date of Service Edit: Clinical

J0400 39 3 Date of Service Edit: Clinical

J0401 400 3 Date of Service Edit: Clinical

J0456 4 3 Date of Service Edit: Clinical

J0461 200 3 Date of Service Edit: Clinical

J0470 2 3 Date of Service Edit: Clinical

J0475 8 3 Date of Service Edit: Clinical

J0476 2 3 Date of Service Edit: Clinical

J0480 1 3 Date of Service Edit: Clinical

J0485 1500 3 Date of Service Edit: Clinical

J0490 160 3 Date of Service Edit: Clinical

J0500 4 3 Date of Service Edit: Clinical

J0515 3 3 Date of Service Edit: Clinical

J0520 0 3 Date of Service Edit: Clinical

J0558 24 3 Date of Service Edit: Clinical

J0561 24 3 Date of Service Edit: Clinical

J0571 0 3 Date of Service Edit: Clinical

J0572 0 3 Date of Service Edit: Clinical

J0573 0 3 Date of Service Edit: Clinical

J0574 0 3 Date of Service Edit: Clinical

J0575 0 3 Date of Service Edit: Clinical

J0583 250 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ0585 600 3 Date of Service Edit: Clinical

J0586 300 3 Date of Service Edit: Clinical

J0587 300 3 Date of Service Edit: Clinical

J0588 600 3 Date of Service Edit: Clinical

J0592 6 3 Date of Service Edit: Clinical

J0594 320 3 Date of Service Edit: Clinical

J0595 8 3 Date of Service Edit: Clinical

J0596 840 3 Date of Service Edit: Clinical

J0597 250 3 Date of Service Edit: Clinical

J0598 100 3 Date of Service Edit: Clinical

J0600 3 3 Date of Service Edit: Clinical

J0610 15 3 Date of Service Edit: Clinical

J0620 1 3 Date of Service Edit: Clinical

J0630 1 3 Date of Service Edit: Clinical

J0636 100 3 Date of Service Edit: Clinical

J0637 20 3 Date of Service Edit: Clinical

J0638 180 3 Date of Service Edit: Clinical

J0640 24 3 Date of Service Edit: Clinical

J0641 1200 3 Date of Service Edit: Clinical

J0670 10 3 Date of Service Edit: Clinical

J0690 12 3 Date of Service Edit: Clinical

J0692 12 3 Date of Service Edit: Clinical

J0694 8 3 Date of Service Edit: Clinical

J0695 60 3 Date of Service Edit: Clinical

J0696 16 3 Date of Service Edit: Clinical

J0697 4 3 Date of Service Edit: Clinical

J0698 10 3 Date of Service Edit: Clinical

J0702 18 3 Date of Service Edit: Clinical

J0706 1 3 Date of Service Edit: Clinical

J0710 0 3 Date of Service Edit: Clinical

J0712 120 3 Date of Service Edit: Clinical

J0713 12 3 Date of Service Edit: Clinical

J0714 4 1 Line Edit

J0715 0 3 Date of Service Edit: Clinical

J0716 4 1 Line Edit

J0717 400 3 Date of Service Edit: Clinical

J0720 15 3 Date of Service Edit: Clinical

J0725 10 3 Date of Service Edit: Clinical

J0735 50 3 Date of Service Edit: Clinical

J0740 2 3 Date of Service Edit: Clinical

J0743 16 3 Date of Service Edit: Clinical

J0744 6 3 Date of Service Edit: Clinical

J0745 2 3 Date of Service Edit: Clinical

J0760 4 3 Date of Service Edit: Clinical

15

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ0770 5 3 Date of Service Edit: Clinical

J0775 180 3 Date of Service Edit: Clinical

J0780 4 3 Date of Service Edit: Clinical

J0795 100 3 Date of Service Edit: Clinical

J0800 3 3 Date of Service Edit: Clinical

J0833 3 3 Date of Service Edit: Clinical

J0834 3 3 Date of Service Edit: Clinical

J0840 6 3 Date of Service Edit: Clinical

J0850 9 3 Date of Service Edit: Clinical

J0875 300 3 Date of Service Edit: Clinical

J0878 1500 3 Date of Service Edit: Clinical

J0881 500 3 Date of Service Edit: Clinical

J0882 200 3 Date of Service Edit: Clinical

J0885 60 1 Line Edit

J0887 360 1 Line Edit

J0888 360 1 Line Edit

J0890 0 2 Date of Service Edit: Policy

J0894 100 3 Date of Service Edit: Clinical

J0895 12 3 Date of Service Edit: Clinical

J0897 120 3 Date of Service Edit: Clinical

J0945 4 3 Date of Service Edit: Clinical

J1000 1 3 Date of Service Edit: Clinical

J1020 8 3 Date of Service Edit: Clinical

J1030 8 3 Date of Service Edit: Clinical

J1040 4 3 Date of Service Edit: Clinical

J1050 1000 3 Date of Service Edit: Clinical

J1071 400 3 Date of Service Edit: Clinical

J1094 0 3 Date of Service Edit: Clinical

J1100 120 3 Date of Service Edit: Clinical

J1110 3 3 Date of Service Edit: Clinical

J1120 2 3 Date of Service Edit: Clinical

J1160 2 3 Date of Service Edit: Clinical

J1162 1 3 Date of Service Edit: Clinical

J1165 50 3 Date of Service Edit: Clinical

J1170 350 3 Date of Service Edit: Clinical

J1180 2 3 Date of Service Edit: Clinical

J1190 8 3 Date of Service Edit: Clinical

J1200 8 3 Date of Service Edit: Clinical

J1205 4 3 Date of Service Edit: Clinical

J1212 1 3 Date of Service Edit: Clinical

J1230 3 3 Date of Service Edit: Clinical

J1240 6 3 Date of Service Edit: Clinical

J1245 6 3 Date of Service Edit: Clinical

J1250 2 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ1260 2 3 Date of Service Edit: Clinical

J1265 20 3 Date of Service Edit: Clinical

J1267 150 3 Date of Service Edit: Clinical

J1270 8 3 Date of Service Edit: Clinical

J1290 30 3 Date of Service Edit: Clinical

J1300 120 3 Date of Service Edit: Clinical

J1320 0 3 Date of Service Edit: Clinical

J1322 220 1 Line Edit

J1324 108 3 Date of Service Edit: Clinical

J1325 1 3 Date of Service Edit: Clinical

J1327 1 3 Date of Service Edit: Clinical

J1330 1 3 Date of Service Edit: Clinical

J1335 2 3 Date of Service Edit: Clinical

J1364 2 3 Date of Service Edit: Clinical

J1380 4 3 Date of Service Edit: Clinical

J1410 4 3 Date of Service Edit: Clinical

J1430 10 3 Date of Service Edit: Clinical

J1435 1 3 Date of Service Edit: Clinical

J1436 0 3 Date of Service Edit: Clinical

J1438 2 3 Date of Service Edit: Clinical

J1439 750 3 Date of Service Edit: Clinical

J1442 3360 3 Date of Service Edit: Clinical

J1443 1 3 Date of Service Edit: Clinical

J1447 960 3 Date of Service Edit: Clinical

J1450 4 3 Date of Service Edit: Clinical

J1451 1 3 Date of Service Edit: Clinical

J1452 0 3 Date of Service Edit: Clinical

J1453 150 3 Date of Service Edit: Clinical

J1455 18 3 Date of Service Edit: Clinical

J1457 500 3 Date of Service Edit: Clinical

J1458 100 3 Date of Service Edit: Clinical

J1459 300 1 Line Edit

J1460 10 2 Date of Service Edit: Policy

J1556 300 3 Date of Service Edit: Clinical

J1557 300 3 Date of Service Edit: Clinical

J1559 375 1 Line Edit

J1560 1 2 Date of Service Edit: Policy

J1561 300 3 Date of Service Edit: Clinical

J1562 375 1 Line Edit

J1566 300 1 Line Edit

J1568 300 3 Date of Service Edit: Clinical

J1569 300 3 Date of Service Edit: Clinical

J1570 4 3 Date of Service Edit: Clinical

J1571 20 3 Date of Service Edit: Clinical

16

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ1572 300 3 Date of Service Edit: Clinical

J1575 900 1 Line Edit

J1580 9 3 Date of Service Edit: Clinical

J1590 0 3 Date of Service Edit: Clinical

J1595 1 3 Date of Service Edit: Clinical

J1599 300 3 Date of Service Edit: Clinical

J1600 2 3 Date of Service Edit: Clinical

J1602 300 3 Date of Service Edit: Clinical

J1610 2 3 Date of Service Edit: Clinical

J1620 0 3 Date of Service Edit: Clinical

J1626 30 3 Date of Service Edit: Clinical

J1630 5 3 Date of Service Edit: Clinical

J1631 9 3 Date of Service Edit: Clinical

J1640 626 3 Date of Service Edit: Clinical

J1642 40 3 Date of Service Edit: Clinical

J1644 40 3 Date of Service Edit: Clinical

J1645 10 3 Date of Service Edit: Clinical

J1650 30 3 Date of Service Edit: Clinical

J1652 20 3 Date of Service Edit: Clinical

J1655 0 3 Date of Service Edit: Clinical

J1670 1 3 Date of Service Edit: Clinical

J1675 0 3 Date of Service Edit: Clinical

J1700 0 3 Date of Service Edit: Clinical

J1710 0 3 Date of Service Edit: Clinical

J1720 10 3 Date of Service Edit: Clinical

J1725 250 3 Date of Service Edit: Clinical

J1730 0 3 Date of Service Edit: Clinical

J1740 3 3 Date of Service Edit: Clinical

J1741 8 3 Date of Service Edit: Clinical

J1742 2 3 Date of Service Edit: Clinical

J1743 66 3 Date of Service Edit: Clinical

J1744 30 3 Date of Service Edit: Clinical

J1745 150 3 Date of Service Edit: Clinical

J1750 45 3 Date of Service Edit: Clinical

J1756 500 3 Date of Service Edit: Clinical

J1786 900 3 Date of Service Edit: Clinical

J1790 2 3 Date of Service Edit: Clinical

J1800 6 3 Date of Service Edit: Clinical

J1810 0 3 Date of Service Edit: Clinical

J1815 8 3 Date of Service Edit: Clinical

J1817 0 3 Date of Service Edit: Clinical

J1830 1 3 Date of Service Edit: Clinical

J1833 372 3 Date of Service Edit: Clinical

J1835 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ1840 3 3 Date of Service Edit: Clinical

J1850 4 3 Date of Service Edit: Clinical

J1885 8 3 Date of Service Edit: Clinical

J1890 0 3 Date of Service Edit: Clinical

J1930 120 3 Date of Service Edit: Clinical

J1931 760 3 Date of Service Edit: Clinical

J1940 6 3 Date of Service Edit: Clinical

J1945 0 3 Date of Service Edit: Clinical

J1950 12 3 Date of Service Edit: Clinical

J1953 300 3 Date of Service Edit: Clinical

J1955 11 3 Date of Service Edit: Clinical

J1956 4 3 Date of Service Edit: Clinical

J1960 0 3 Date of Service Edit: Clinical

J1980 2 3 Date of Service Edit: Clinical

J1990 0 3 Date of Service Edit: Clinical

J2001 60 3 Date of Service Edit: Clinical

J2010 10 3 Date of Service Edit: Clinical

J2020 6 3 Date of Service Edit: Clinical

J2060 4 3 Date of Service Edit: Clinical

J2150 8 3 Date of Service Edit: Clinical

J2170 8 3 Date of Service Edit: Clinical

J2175 4 3 Date of Service Edit: Clinical

J2180 0 3 Date of Service Edit: Clinical

J2185 30 3 Date of Service Edit: Clinical

J2210 1 3 Date of Service Edit: Clinical

J2212 240 3 Date of Service Edit: Clinical

J2248 150 3 Date of Service Edit: Clinical

J2250 22 3 Date of Service Edit: Clinical

J2260 4 3 Date of Service Edit: Clinical

J2265 400 3 Date of Service Edit: Clinical

J2270 9 3 Date of Service Edit: Clinical

J2274 250 3 Date of Service Edit: Clinical

J2278 999 3 Date of Service Edit: Clinical

J2280 4 3 Date of Service Edit: Clinical

J2300 4 3 Date of Service Edit: Clinical

J2310 4 3 Date of Service Edit: Clinical

J2315 380 3 Date of Service Edit: Clinical

J2320 4 3 Date of Service Edit: Clinical

J2323 300 3 Date of Service Edit: Clinical

J2325 0 3 Date of Service Edit: Clinical

J2353 60 3 Date of Service Edit: Clinical

J2354 60 3 Date of Service Edit: Clinical

J2355 2 3 Date of Service Edit: Clinical

J2357 90 3 Date of Service Edit: Clinical

17

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ2358 405 3 Date of Service Edit: Clinical

J2360 2 3 Date of Service Edit: Clinical

J2370 2 3 Date of Service Edit: Clinical

J2400 4 3 Date of Service Edit: Clinical

J2405 64 3 Date of Service Edit: Clinical

J2407 120 3 Date of Service Edit: Clinical

J2410 2 3 Date of Service Edit: Clinical

J2425 125 3 Date of Service Edit: Clinical

J2426 819 3 Date of Service Edit: Clinical

J2430 3 3 Date of Service Edit: Clinical

J2440 4 3 Date of Service Edit: Clinical

J2460 0 3 Date of Service Edit: Clinical

J2469 10 3 Date of Service Edit: Clinical

J2501 2 3 Date of Service Edit: Clinical

J2502 60 1 Line Edit

J2503 2 3 Date of Service Edit: Clinical

J2504 15 3 Date of Service Edit: Clinical

J2505 1 3 Date of Service Edit: Clinical

J2507 8 3 Date of Service Edit: Clinical

J2510 4 3 Date of Service Edit: Clinical

J2513 1 3 Date of Service Edit: Clinical

J2515 1 3 Date of Service Edit: Clinical

J2540 75 3 Date of Service Edit: Clinical

J2543 16 3 Date of Service Edit: Clinical

J2545 1 3 Date of Service Edit: Clinical

J2547 600 3 Date of Service Edit: Clinical

J2550 3 3 Date of Service Edit: Clinical

J2560 1 3 Date of Service Edit: Clinical

J2562 48 3 Date of Service Edit: Clinical

J2590 3 3 Date of Service Edit: Clinical

J2597 45 3 Date of Service Edit: Clinical

J2650 0 3 Date of Service Edit: Clinical

J2670 0 3 Date of Service Edit: Clinical

J2675 1 3 Date of Service Edit: Clinical

J2680 4 3 Date of Service Edit: Clinical

J2690 4 3 Date of Service Edit: Clinical

J2700 48 3 Date of Service Edit: Clinical

J2704 80 3 Date of Service Edit: Clinical

J2710 2 3 Date of Service Edit: Clinical

J2720 5 3 Date of Service Edit: Clinical

J2724 4000 3 Date of Service Edit: Clinical

J2725 0 3 Date of Service Edit: Clinical

J2730 2 3 Date of Service Edit: Clinical

J2760 2 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ2765 10 3 Date of Service Edit: Clinical

J2770 6 3 Date of Service Edit: Clinical

J2778 10 3 Date of Service Edit: Clinical

J2780 16 3 Date of Service Edit: Clinical

J2783 60 3 Date of Service Edit: Clinical

J2785 4 3 Date of Service Edit: Clinical

J2788 1 3 Date of Service Edit: Clinical

J2791 50 3 Date of Service Edit: Clinical

J2793 320 3 Date of Service Edit: Clinical

J2794 100 3 Date of Service Edit: Clinical

J2795 200 3 Date of Service Edit: Clinical

J2796 150 3 Date of Service Edit: Clinical

J2800 3 3 Date of Service Edit: Clinical

J2805 3 3 Date of Service Edit: Clinical

J2810 5 3 Date of Service Edit: Clinical

J2820 15 3 Date of Service Edit: Clinical

J2850 16 3 Date of Service Edit: Clinical

J2860 170 3 Date of Service Edit: Clinical

J2910 0 3 Date of Service Edit: Clinical

J2916 20 3 Date of Service Edit: Clinical

J2920 25 3 Date of Service Edit: Clinical

J2930 25 3 Date of Service Edit: Clinical

J2940 0 3 Date of Service Edit: Clinical

J2941 8 3 Date of Service Edit: Clinical

J2950 0 3 Date of Service Edit: Clinical

J2993 2 3 Date of Service Edit: Clinical

J2995 0 3 Date of Service Edit: Clinical

J2997 8 3 Date of Service Edit: Clinical

J3000 2 3 Date of Service Edit: Clinical

J3010 100 3 Date of Service Edit: Clinical

J3030 1 3 Date of Service Edit: Clinical

J3060 900 3 Date of Service Edit: Clinical

J3070 3 3 Date of Service Edit: Clinical

J3090 200 3 Date of Service Edit: Clinical

J3095 150 3 Date of Service Edit: Clinical

J3101 50 3 Date of Service Edit: Clinical

J3105 2 3 Date of Service Edit: Clinical

J3110 2 3 Date of Service Edit: Clinical

J3121 400 3 Date of Service Edit: Clinical

J3145 750 3 Date of Service Edit: Clinical

J3230 2 3 Date of Service Edit: Clinical

J3240 1 3 Date of Service Edit: Clinical

J3243 150 3 Date of Service Edit: Clinical

J3246 1 3 Date of Service Edit: Clinical

18

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ3250 2 3 Date of Service Edit: Clinical

J3260 8 3 Date of Service Edit: Clinical

J3262 800 3 Date of Service Edit: Clinical

J3265 0 3 Date of Service Edit: Clinical

J3280 0 3 Date of Service Edit: Clinical

J3285 1 3 Date of Service Edit: Clinical

J3300 160 3 Date of Service Edit: Clinical

J3301 16 3 Date of Service Edit: Clinical

J3302 0 3 Date of Service Edit: Clinical

J3303 24 3 Date of Service Edit: Clinical

J3305 0 3 Date of Service Edit: Clinical

J3310 0 3 Date of Service Edit: Clinical

J3315 6 3 Date of Service Edit: Clinical

J3320 0 3 Date of Service Edit: Clinical

J3350 0 3 Date of Service Edit: Clinical

J3355 1 3 Date of Service Edit: Clinical

J3357 90 3 Date of Service Edit: Clinical

J3360 6 3 Date of Service Edit: Clinical

J3364 0 3 Date of Service Edit: Clinical

J3365 0 3 Date of Service Edit: Clinical

J3370 12 3 Date of Service Edit: Clinical

J3380 300 3 Date of Service Edit: Clinical

J3385 92 3 Date of Service Edit: Clinical

J3396 150 3 Date of Service Edit: Clinical

J3400 0 3 Date of Service Edit: Clinical

J3410 8 3 Date of Service Edit: Clinical

J3411 4 3 Date of Service Edit: Clinical

J3415 6 3 Date of Service Edit: Clinical

J3420 1 3 Date of Service Edit: Clinical

J3430 25 3 Date of Service Edit: Clinical

J3465 40 3 Date of Service Edit: Clinical

J3470 3 3 Date of Service Edit: Clinical

J3471 999 2 Date of Service Edit: Policy

J3472 2 3 Date of Service Edit: Clinical

J3473 450 3 Date of Service Edit: Clinical

J3475 20 3 Date of Service Edit: Clinical

J3480 40 3 Date of Service Edit: Clinical

J3485 160 3 Date of Service Edit: Clinical

J3486 4 3 Date of Service Edit: Clinical

J3489 5 3 Date of Service Edit: Clinical

J3520 0 3 Date of Service Edit: Clinical

J3530 0 3 Date of Service Edit: Clinical

J7030 5 3 Date of Service Edit: Clinical

J7040 6 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ7042 6 3 Date of Service Edit: Clinical

J7050 10 3 Date of Service Edit: Clinical

J7060 10 3 Date of Service Edit: Clinical

J7070 4 3 Date of Service Edit: Clinical

J7100 2 3 Date of Service Edit: Clinical

J7110 2 3 Date of Service Edit: Clinical

J7120 4 3 Date of Service Edit: Clinical

J7121 4 3 Date of Service Edit: Clinical

J7131 500 3 Date of Service Edit: Clinical

J7178 7700 1 Line Edit

J7180 6000 1 Line Edit

J7181 3850 1 Line Edit

J7182 22000 1 Line Edit

J7183 15000 1 Line Edit

J7185 4000 1 Line Edit

J7186 8000 1 Line Edit

J7187 7500 1 Line Edit

J7188 22000 1 Line Edit

J7189 13000 1 Line Edit

J7190 30000 1 Line Edit

J7191 0 3 Date of Service Edit: Clinical

J7192 22000 1 Line Edit

J7193 4000 1 Line Edit

J7194 9000 1 Line Edit

J7195 6000 1 Line Edit

J7196 175 3 Date of Service Edit: Clinical

J7197 6300 1 Line Edit

J7198 6000 1 Line Edit

J7200 20000 1 Line Edit

J7201 9000 1 Line Edit

J7205 9750 1 Line Edit

J7297 1 3 Date of Service Edit: Clinical

J7298 1 3 Date of Service Edit: Clinical

J7301 0 3 Date of Service Edit: Clinical

J7308 3 3 Date of Service Edit: Clinical

J7309 1 3 Date of Service Edit: Clinical

J7310 2 2 Date of Service Edit: Policy

J7311 1 3 Date of Service Edit: Clinical

J7312 14 3 Date of Service Edit: Clinical

J7313 19 1 Line Edit

J7315 2 3 Date of Service Edit: Clinical

J7316 4 2 Date of Service Edit: Policy

J7321 2 2 Date of Service Edit: Policy

J7323 2 2 Date of Service Edit: Policy

19

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ7324 2 2 Date of Service Edit: Policy

J7325 96 3 Date of Service Edit: Clinical

J7326 2 2 Date of Service Edit: Policy

J7327 2 2 Date of Service Edit: Policy

J7328 336 3 Date of Service Edit: Clinical

J7330 1 3 Date of Service Edit: Clinical

J7336 1120 3 Date of Service Edit: Clinical

J7340 100 3 Date of Service Edit: Clinical

J7500 0 3 Date of Service Edit: Clinical

J7501 1 3 Date of Service Edit: Clinical

J7502 0 3 Date of Service Edit: Clinical

J7504 15 3 Date of Service Edit: Clinical

J7505 1 3 Date of Service Edit: Clinical

J7507 0 3 Date of Service Edit: Clinical

J7508 0 3 Date of Service Edit: Clinical

J7509 0 3 Date of Service Edit: Clinical

J7510 0 3 Date of Service Edit: Clinical

J7511 9 3 Date of Service Edit: Clinical

J7512 0 3 Date of Service Edit: Clinical

J7513 6 3 Date of Service Edit: Clinical

J7515 0 3 Date of Service Edit: Clinical

J7516 1 3 Date of Service Edit: Clinical

J7517 0 3 Date of Service Edit: Clinical

J7518 0 3 Date of Service Edit: Clinical

J7520 0 3 Date of Service Edit: Clinical

J7525 2 3 Date of Service Edit: Clinical

J7527 0 3 Date of Service Edit: Clinical

J7604 0 3 Date of Service Edit: Clinical

J7605 2 3 Date of Service Edit: Clinical

J7606 2 3 Date of Service Edit: Clinical

J7607 0 3 Date of Service Edit: Clinical

J7608 3 3 Date of Service Edit: Clinical

J7609 0 3 Date of Service Edit: Clinical

J7610 0 3 Date of Service Edit: Clinical

J7611 10 3 Date of Service Edit: Clinical

J7612 10 3 Date of Service Edit: Clinical

J7613 10 3 Date of Service Edit: Clinical

J7614 10 3 Date of Service Edit: Clinical

J7615 0 3 Date of Service Edit: Clinical

J7620 6 3 Date of Service Edit: Clinical

J7622 0 3 Date of Service Edit: Clinical

J7624 0 3 Date of Service Edit: Clinical

J7626 2 3 Date of Service Edit: Clinical

J7627 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ7628 0 3 Date of Service Edit: Clinical

J7629 0 3 Date of Service Edit: Clinical

J7631 4 3 Date of Service Edit: Clinical

J7632 0 3 Date of Service Edit: Clinical

J7633 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

J7639 3 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

J7644 3 3 Date of Service Edit: Clinical

J7645 0 3 Date of Service Edit: Clinical

J7647 0 3 Date of Service Edit: Clinical

J7648 0 3 Date of Service Edit: Clinical

J7649 0 3 Date of Service Edit: Clinical

J7650 0 3 Date of Service Edit: Clinical

J7657 0 3 Date of Service Edit: Clinical

J7658 0 3 Date of Service Edit: Clinical

J7659 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

J7668 0 3 Date of Service Edit: Clinical

J7669 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

J7682 2 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

J7686 1 3 Date of Service Edit: Clinical

J8501 0 3 Date of Service Edit: Clinical

J8510 0 3 Date of Service Edit: Clinical

J8520 0 3 Date of Service Edit: Clinical

J8521 0 3 Date of Service Edit: Clinical

J8530 0 3 Date of Service Edit: Clinical

J8540 0 3 Date of Service Edit: Clinical

20

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ8560 0 3 Date of Service Edit: Clinical

J8562 0 3 Date of Service Edit: Clinical

J8600 0 3 Date of Service Edit: Clinical

J8610 0 3 Date of Service Edit: Clinical

J8650 0 3 Date of Service Edit: Clinical

J8655 0 3 Date of Service Edit: Clinical

J8700 0 3 Date of Service Edit: Clinical

J8705 0 3 Date of Service Edit: Clinical

J9000 20 3 Date of Service Edit: Clinical

J9015 1 3 Date of Service Edit: Clinical

J9017 30 3 Date of Service Edit: Clinical

J9019 60 3 Date of Service Edit: Clinical

J9020 0 3 Date of Service Edit: Clinical

J9025 300 3 Date of Service Edit: Clinical

J9027 100 3 Date of Service Edit: Clinical

J9031 1 3 Date of Service Edit: Clinical

J9032 300 3 Date of Service Edit: Clinical

J9033 300 3 Date of Service Edit: Clinical

J9035 180 3 Date of Service Edit: Clinical

J9039 35 3 Date of Service Edit: Clinical

J9040 4 3 Date of Service Edit: Clinical

J9041 35 3 Date of Service Edit: Clinical

J9042 200 3 Date of Service Edit: Clinical

J9043 60 3 Date of Service Edit: Clinical

J9045 22 3 Date of Service Edit: Clinical

J9047 120 3 Date of Service Edit: Clinical

J9050 6 3 Date of Service Edit: Clinical

J9055 120 3 Date of Service Edit: Clinical

J9060 24 3 Date of Service Edit: Clinical

J9065 20 3 Date of Service Edit: Clinical

J9070 55 3 Date of Service Edit: Clinical

J9098 5 3 Date of Service Edit: Clinical

J9100 120 3 Date of Service Edit: Clinical

J9120 5 3 Date of Service Edit: Clinical

J9130 24 3 Date of Service Edit: Clinical

J9150 12 3 Date of Service Edit: Clinical

J9151 10 3 Date of Service Edit: Clinical

J9155 240 3 Date of Service Edit: Clinical

J9160 7 3 Date of Service Edit: Clinical

J9165 0 3 Date of Service Edit: Clinical

J9171 240 3 Date of Service Edit: Clinical

J9175 10 3 Date of Service Edit: Clinical

J9178 150 3 Date of Service Edit: Clinical

J9179 50 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ9185 2 3 Date of Service Edit: Clinical

J9190 20 3 Date of Service Edit: Clinical

J9200 5 3 Date of Service Edit: Clinical

J9201 20 3 Date of Service Edit: Clinical

J9202 3 3 Date of Service Edit: Clinical

J9206 42 3 Date of Service Edit: Clinical

J9207 90 3 Date of Service Edit: Clinical

J9208 15 3 Date of Service Edit: Clinical

J9209 55 3 Date of Service Edit: Clinical

J9211 6 3 Date of Service Edit: Clinical

J9212 0 3 Date of Service Edit: Clinical

J9213 12 3 Date of Service Edit: Clinical

J9214 100 3 Date of Service Edit: Clinical

J9215 0 3 Date of Service Edit: Clinical

J9216 2 3 Date of Service Edit: Clinical

J9217 6 3 Date of Service Edit: Clinical

J9218 1 3 Date of Service Edit: Clinical

J9219 1 3 Date of Service Edit: Clinical

J9225 1 3 Date of Service Edit: Clinical

J9226 1 3 Date of Service Edit: Clinical

J9228 1100 3 Date of Service Edit: Clinical

J9230 5 3 Date of Service Edit: Clinical

J9245 9 3 Date of Service Edit: Clinical

J9250 25 3 Date of Service Edit: Clinical

J9260 20 3 Date of Service Edit: Clinical

J9261 80 3 Date of Service Edit: Clinical

J9262 700 3 Date of Service Edit: Clinical

J9263 700 3 Date of Service Edit: Clinical

J9266 2 3 Date of Service Edit: Clinical

J9267 750 3 Date of Service Edit: Clinical

J9268 1 3 Date of Service Edit: Clinical

J9270 0 3 Date of Service Edit: Clinical

J9271 300 3 Date of Service Edit: Clinical

J9280 12 3 Date of Service Edit: Clinical

J9293 8 3 Date of Service Edit: Clinical

J9299 440 3 Date of Service Edit: Clinical

J9300 0 3 Date of Service Edit: Clinical

J9301 100 3 Date of Service Edit: Clinical

J9302 200 3 Date of Service Edit: Clinical

J9303 100 3 Date of Service Edit: Clinical

J9305 150 3 Date of Service Edit: Clinical

J9306 840 3 Date of Service Edit: Clinical

J9307 80 3 Date of Service Edit: Clinical

J9308 300 3 Date of Service Edit: Clinical

21

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorJ9310 12 3 Date of Service Edit: Clinical

J9315 40 3 Date of Service Edit: Clinical

J9320 4 3 Date of Service Edit: Clinical

J9328 400 3 Date of Service Edit: Clinical

J9330 50 3 Date of Service Edit: Clinical

J9340 4 3 Date of Service Edit: Clinical

J9351 120 3 Date of Service Edit: Clinical

J9354 600 3 Date of Service Edit: Clinical

J9355 100 3 Date of Service Edit: Clinical

J9357 4 3 Date of Service Edit: Clinical

J9360 45 3 Date of Service Edit: Clinical

J9370 4 3 Date of Service Edit: Clinical

J9371 5 3 Date of Service Edit: Clinical

J9390 36 3 Date of Service Edit: Clinical

J9395 20 3 Date of Service Edit: Clinical

J9400 600 3 Date of Service Edit: Clinical

J9600 4 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

K0009 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

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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorK0053 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

K0602 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

K0672 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

K0744 0 3 Date of Service Edit: Clinical

K0745 0 3 Date of Service Edit: Clinical

K0746 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

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

22

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorK0826 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

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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorK0891 0 3 Date of Service Edit: Clinical

K0898 1 2 Date of Service Edit: Policy

K0900 0 3 Date of Service Edit: Clinical

K0901 0 3 Date of Service Edit: Clinical

K0902 0 3 Date of Service Edit: Clinical

L0112 0 3 Date of Service Edit: Clinical

L0113 0 3 Date of Service Edit: Clinical

L0120 0 3 Date of Service Edit: Clinical

L0130 0 3 Date of Service Edit: Clinical

L0140 0 3 Date of Service Edit: Clinical

L0150 0 3 Date of Service Edit: Clinical

L0160 0 3 Date of Service Edit: Clinical

L0170 0 3 Date of Service Edit: Clinical

L0172 0 3 Date of Service Edit: Clinical

L0174 0 3 Date of Service Edit: Clinical

L0180 0 3 Date of Service Edit: Clinical

L0190 0 3 Date of Service Edit: Clinical

L0200 0 3 Date of Service Edit: Clinical

L0220 0 3 Date of Service Edit: Clinical

L0450 0 3 Date of Service Edit: Clinical

L0452 0 3 Date of Service Edit: Clinical

L0454 0 3 Date of Service Edit: Clinical

L0455 0 3 Date of Service Edit: Clinical

L0456 0 3 Date of Service Edit: Clinical

L0457 0 3 Date of Service Edit: Clinical

L0458 0 3 Date of Service Edit: Clinical

L0460 0 3 Date of Service Edit: Clinical

L0462 0 3 Date of Service Edit: Clinical

L0464 0 3 Date of Service Edit: Clinical

L0466 0 3 Date of Service Edit: Clinical

L0467 0 3 Date of Service Edit: Clinical

L0468 0 3 Date of Service Edit: Clinical

L0469 0 3 Date of Service Edit: Clinical

L0470 0 3 Date of Service Edit: Clinical

L0472 0 3 Date of Service Edit: Clinical

L0480 0 3 Date of Service Edit: Clinical

L0482 0 3 Date of Service Edit: Clinical

L0484 0 3 Date of Service Edit: Clinical

L0486 0 3 Date of Service Edit: Clinical

L0488 0 3 Date of Service Edit: Clinical

L0490 0 3 Date of Service Edit: Clinical

L0491 0 3 Date of Service Edit: Clinical

L0492 0 3 Date of Service Edit: Clinical

L0621 0 3 Date of Service Edit: Clinical

23

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL0622 0 3 Date of Service Edit: Clinical

L0623 0 3 Date of Service Edit: Clinical

L0624 0 3 Date of Service Edit: Clinical

L0625 0 3 Date of Service Edit: Clinical

L0626 0 3 Date of Service Edit: Clinical

L0627 0 3 Date of Service Edit: Clinical

L0628 0 3 Date of Service Edit: Clinical

L0629 0 3 Date of Service Edit: Clinical

L0630 0 3 Date of Service Edit: Clinical

L0631 0 3 Date of Service Edit: Clinical

L0632 0 3 Date of Service Edit: Clinical

L0633 0 3 Date of Service Edit: Clinical

L0634 0 3 Date of Service Edit: Clinical

L0635 0 3 Date of Service Edit: Clinical

L0636 0 3 Date of Service Edit: Clinical

L0637 0 3 Date of Service Edit: Clinical

L0638 0 3 Date of Service Edit: Clinical

L0639 0 3 Date of Service Edit: Clinical

L0640 0 3 Date of Service Edit: Clinical

L0641 0 3 Date of Service Edit: Clinical

L0642 0 3 Date of Service Edit: Clinical

L0643 0 3 Date of Service Edit: Clinical

L0648 0 3 Date of Service Edit: Clinical

L0649 0 3 Date of Service Edit: Clinical

L0650 0 3 Date of Service Edit: Clinical

L0651 0 3 Date of Service Edit: Clinical

L0700 0 3 Date of Service Edit: Clinical

L0710 0 3 Date of Service Edit: Clinical

L0810 0 3 Date of Service Edit: Clinical

L0820 0 3 Date of Service Edit: Clinical

L0830 0 3 Date of Service Edit: Clinical

L0859 0 3 Date of Service Edit: Clinical

L0861 0 3 Date of Service Edit: Clinical

L0970 0 3 Date of Service Edit: Clinical

L0972 0 3 Date of Service Edit: Clinical

L0974 0 3 Date of Service Edit: Clinical

L0976 0 3 Date of Service Edit: Clinical

L0978 0 3 Date of Service Edit: Clinical

L0980 0 3 Date of Service Edit: Clinical

L0982 0 3 Date of Service Edit: Clinical

L0984 0 3 Date of Service Edit: Clinical

L1000 0 3 Date of Service Edit: Clinical

L1001 0 3 Date of Service Edit: Clinical

L1005 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL1010 0 3 Date of Service Edit: Clinical

L1020 0 3 Date of Service Edit: Clinical

L1025 0 3 Date of Service Edit: Clinical

L1030 0 3 Date of Service Edit: Clinical

L1040 0 3 Date of Service Edit: Clinical

L1050 0 3 Date of Service Edit: Clinical

L1060 0 3 Date of Service Edit: Clinical

L1070 0 3 Date of Service Edit: Clinical

L1080 0 3 Date of Service Edit: Clinical

L1085 0 3 Date of Service Edit: Clinical

L1090 0 3 Date of Service Edit: Clinical

L1100 0 3 Date of Service Edit: Clinical

L1110 0 3 Date of Service Edit: Clinical

L1120 0 3 Date of Service Edit: Clinical

L1200 0 3 Date of Service Edit: Clinical

L1210 0 3 Date of Service Edit: Clinical

L1220 0 3 Date of Service Edit: Clinical

L1230 0 3 Date of Service Edit: Clinical

L1240 0 3 Date of Service Edit: Clinical

L1250 0 3 Date of Service Edit: Clinical

L1260 0 3 Date of Service Edit: Clinical

L1270 0 3 Date of Service Edit: Clinical

L1280 0 3 Date of Service Edit: Clinical

L1290 0 3 Date of Service Edit: Clinical

L1300 0 3 Date of Service Edit: Clinical

L1310 0 3 Date of Service Edit: Clinical

L1499 1 3 Date of Service Edit: Clinical

L1600 0 3 Date of Service Edit: Clinical

L1610 0 3 Date of Service Edit: Clinical

L1620 0 3 Date of Service Edit: Clinical

L1630 0 3 Date of Service Edit: Clinical

L1640 0 3 Date of Service Edit: Clinical

L1650 0 3 Date of Service Edit: Clinical

L1652 0 3 Date of Service Edit: Clinical

L1660 0 3 Date of Service Edit: Clinical

L1680 0 3 Date of Service Edit: Clinical

L1685 0 3 Date of Service Edit: Clinical

L1686 0 3 Date of Service Edit: Clinical

L1690 0 3 Date of Service Edit: Clinical

L1700 0 3 Date of Service Edit: Clinical

L1710 0 3 Date of Service Edit: Clinical

L1720 0 3 Date of Service Edit: Clinical

L1730 0 3 Date of Service Edit: Clinical

L1755 0 3 Date of Service Edit: Clinical

24

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL1810 0 3 Date of Service Edit: Clinical

L1812 0 3 Date of Service Edit: Clinical

L1820 0 3 Date of Service Edit: Clinical

L1830 0 3 Date of Service Edit: Clinical

L1831 0 3 Date of Service Edit: Clinical

L1832 0 3 Date of Service Edit: Clinical

L1833 0 3 Date of Service Edit: Clinical

L1834 0 3 Date of Service Edit: Clinical

L1836 0 3 Date of Service Edit: Clinical

L1840 0 3 Date of Service Edit: Clinical

L1843 0 3 Date of Service Edit: Clinical

L1844 0 3 Date of Service Edit: Clinical

L1845 0 3 Date of Service Edit: Clinical

L1846 0 3 Date of Service Edit: Clinical

L1847 0 3 Date of Service Edit: Clinical

L1848 0 3 Date of Service Edit: Clinical

L1850 0 3 Date of Service Edit: Clinical

L1860 0 3 Date of Service Edit: Clinical

L1900 0 3 Date of Service Edit: Clinical

L1902 0 3 Date of Service Edit: Clinical

L1904 0 3 Date of Service Edit: Clinical

L1906 0 3 Date of Service Edit: Clinical

L1907 0 3 Date of Service Edit: Clinical

L1910 0 3 Date of Service Edit: Clinical

L1920 0 3 Date of Service Edit: Clinical

L1930 0 3 Date of Service Edit: Clinical

L1932 0 3 Date of Service Edit: Clinical

L1940 0 3 Date of Service Edit: Clinical

L1945 0 3 Date of Service Edit: Clinical

L1950 0 3 Date of Service Edit: Clinical

L1951 0 3 Date of Service Edit: Clinical

L1960 0 3 Date of Service Edit: Clinical

L1970 0 3 Date of Service Edit: Clinical

L1971 0 3 Date of Service Edit: Clinical

L1980 0 3 Date of Service Edit: Clinical

L1990 0 3 Date of Service Edit: Clinical

L2000 0 3 Date of Service Edit: Clinical

L2005 0 3 Date of Service Edit: Clinical

L2010 0 3 Date of Service Edit: Clinical

L2020 0 3 Date of Service Edit: Clinical

L2030 0 3 Date of Service Edit: Clinical

L2034 0 3 Date of Service Edit: Clinical

L2035 0 3 Date of Service Edit: Clinical

L2036 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL2037 0 3 Date of Service Edit: Clinical

L2038 0 3 Date of Service Edit: Clinical

L2040 0 3 Date of Service Edit: Clinical

L2050 0 3 Date of Service Edit: Clinical

L2060 0 3 Date of Service Edit: Clinical

L2070 0 3 Date of Service Edit: Clinical

L2080 0 3 Date of Service Edit: Clinical

L2090 0 3 Date of Service Edit: Clinical

L2106 0 3 Date of Service Edit: Clinical

L2108 0 3 Date of Service Edit: Clinical

L2112 0 3 Date of Service Edit: Clinical

L2114 0 3 Date of Service Edit: Clinical

L2116 0 3 Date of Service Edit: Clinical

L2126 0 3 Date of Service Edit: Clinical

L2128 0 3 Date of Service Edit: Clinical

L2132 0 3 Date of Service Edit: Clinical

L2134 0 3 Date of Service Edit: Clinical

L2136 0 3 Date of Service Edit: Clinical

L2180 0 3 Date of Service Edit: Clinical

L2182 0 3 Date of Service Edit: Clinical

L2184 0 3 Date of Service Edit: Clinical

L2186 0 3 Date of Service Edit: Clinical

L2188 0 3 Date of Service Edit: Clinical

L2190 0 3 Date of Service Edit: Clinical

L2192 0 3 Date of Service Edit: Clinical

L2200 0 3 Date of Service Edit: Clinical

L2210 0 3 Date of Service Edit: Clinical

L2220 0 3 Date of Service Edit: Clinical

L2230 0 3 Date of Service Edit: Clinical

L2232 0 3 Date of Service Edit: Clinical

L2240 0 3 Date of Service Edit: Clinical

L2250 0 3 Date of Service Edit: Clinical

L2260 0 3 Date of Service Edit: Clinical

L2265 0 3 Date of Service Edit: Clinical

L2270 0 3 Date of Service Edit: Clinical

L2275 0 3 Date of Service Edit: Clinical

L2280 0 3 Date of Service Edit: Clinical

L2300 0 3 Date of Service Edit: Clinical

L2310 0 3 Date of Service Edit: Clinical

L2320 0 3 Date of Service Edit: Clinical

L2330 0 3 Date of Service Edit: Clinical

L2335 0 3 Date of Service Edit: Clinical

L2340 0 3 Date of Service Edit: Clinical

L2350 0 3 Date of Service Edit: Clinical

25

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL2360 0 3 Date of Service Edit: Clinical

L2370 0 3 Date of Service Edit: Clinical

L2375 0 3 Date of Service Edit: Clinical

L2380 0 3 Date of Service Edit: Clinical

L2385 0 3 Date of Service Edit: Clinical

L2387 0 3 Date of Service Edit: Clinical

L2390 0 3 Date of Service Edit: Clinical

L2395 0 3 Date of Service Edit: Clinical

L2397 0 3 Date of Service Edit: Clinical

L2405 0 3 Date of Service Edit: Clinical

L2415 0 3 Date of Service Edit: Clinical

L2425 0 3 Date of Service Edit: Clinical

L2430 0 3 Date of Service Edit: Clinical

L2492 0 3 Date of Service Edit: Clinical

L2500 0 3 Date of Service Edit: Clinical

L2510 0 3 Date of Service Edit: Clinical

L2520 0 3 Date of Service Edit: Clinical

L2525 0 3 Date of Service Edit: Clinical

L2526 0 3 Date of Service Edit: Clinical

L2530 0 3 Date of Service Edit: Clinical

L2540 0 3 Date of Service Edit: Clinical

L2550 0 3 Date of Service Edit: Clinical

L2570 0 3 Date of Service Edit: Clinical

L2580 0 3 Date of Service Edit: Clinical

L2600 0 3 Date of Service Edit: Clinical

L2610 0 3 Date of Service Edit: Clinical

L2620 0 3 Date of Service Edit: Clinical

L2622 0 3 Date of Service Edit: Clinical

L2624 0 3 Date of Service Edit: Clinical

L2627 0 3 Date of Service Edit: Clinical

L2628 0 3 Date of Service Edit: Clinical

L2630 0 3 Date of Service Edit: Clinical

L2640 0 3 Date of Service Edit: Clinical

L2650 0 3 Date of Service Edit: Clinical

L2660 0 3 Date of Service Edit: Clinical

L2670 0 3 Date of Service Edit: Clinical

L2680 0 3 Date of Service Edit: Clinical

L2750 0 3 Date of Service Edit: Clinical

L2755 0 3 Date of Service Edit: Clinical

L2760 0 3 Date of Service Edit: Clinical

L2768 0 3 Date of Service Edit: Clinical

L2780 0 3 Date of Service Edit: Clinical

L2785 0 3 Date of Service Edit: Clinical

L2795 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL2800 0 3 Date of Service Edit: Clinical

L2810 0 3 Date of Service Edit: Clinical

L2820 0 3 Date of Service Edit: Clinical

L2830 0 3 Date of Service Edit: Clinical

L3000 0 3 Date of Service Edit: Clinical

L3001 0 3 Date of Service Edit: Clinical

L3002 0 3 Date of Service Edit: Clinical

L3003 0 3 Date of Service Edit: Clinical

L3010 0 3 Date of Service Edit: Clinical

L3020 0 3 Date of Service Edit: Clinical

L3030 0 3 Date of Service Edit: Clinical

L3031 0 3 Date of Service Edit: Clinical

L3040 0 3 Date of Service Edit: Clinical

L3050 0 3 Date of Service Edit: Clinical

L3060 0 3 Date of Service Edit: Clinical

L3070 0 3 Date of Service Edit: Clinical

L3080 0 3 Date of Service Edit: Clinical

L3090 0 3 Date of Service Edit: Clinical

L3100 0 3 Date of Service Edit: Clinical

L3140 0 3 Date of Service Edit: Clinical

L3150 0 3 Date of Service Edit: Clinical

L3160 0 3 Date of Service Edit: Clinical

L3170 0 3 Date of Service Edit: Clinical

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 0 3 Date of Service Edit: Clinical

L3225 0 3 Date of Service Edit: Clinical

L3230 0 3 Date of Service Edit: Clinical

L3250 0 3 Date of Service Edit: Clinical

L3251 0 3 Date of Service Edit: Clinical

L3252 0 3 Date of Service Edit: Clinical

L3253 0 3 Date of Service Edit: Clinical

L3300 0 3 Date of Service Edit: Clinical

L3310 0 3 Date of Service Edit: Clinical

L3330 0 3 Date of Service Edit: Clinical

L3332 0 3 Date of Service Edit: Clinical

L3334 0 3 Date of Service Edit: Clinical

L3340 0 3 Date of Service Edit: Clinical

L3350 0 3 Date of Service Edit: Clinical

L3360 0 3 Date of Service Edit: Clinical

26

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL3370 0 3 Date of Service Edit: Clinical

L3380 0 3 Date of Service Edit: Clinical

L3390 0 3 Date of Service Edit: Clinical

L3400 0 3 Date of Service Edit: Clinical

L3410 0 3 Date of Service Edit: Clinical

L3420 0 3 Date of Service Edit: Clinical

L3430 0 3 Date of Service Edit: Clinical

L3440 0 3 Date of Service Edit: Clinical

L3450 0 3 Date of Service Edit: Clinical

L3455 0 3 Date of Service Edit: Clinical

L3460 0 3 Date of Service Edit: Clinical

L3465 0 3 Date of Service Edit: Clinical

L3470 0 3 Date of Service Edit: Clinical

L3480 0 3 Date of Service Edit: Clinical

L3485 0 3 Date of Service Edit: Clinical

L3500 0 3 Date of Service Edit: Clinical

L3510 0 3 Date of Service Edit: Clinical

L3520 0 3 Date of Service Edit: Clinical

L3530 0 3 Date of Service Edit: Clinical

L3540 0 3 Date of Service Edit: Clinical

L3550 0 3 Date of Service Edit: Clinical

L3560 0 3 Date of Service Edit: Clinical

L3570 0 3 Date of Service Edit: Clinical

L3580 0 3 Date of Service Edit: Clinical

L3590 0 3 Date of Service Edit: Clinical

L3595 0 3 Date of Service Edit: Clinical

L3600 0 3 Date of Service Edit: Clinical

L3610 0 3 Date of Service Edit: Clinical

L3620 0 3 Date of Service Edit: Clinical

L3630 0 3 Date of Service Edit: Clinical

L3640 0 3 Date of Service Edit: Clinical

L3650 0 3 Date of Service Edit: Clinical

L3660 0 3 Date of Service Edit: Clinical

L3670 0 3 Date of Service Edit: Clinical

L3671 0 3 Date of Service Edit: Clinical

L3674 0 3 Date of Service Edit: Clinical

L3675 0 3 Date of Service Edit: Clinical

L3677 0 3 Date of Service Edit: Clinical

L3678 0 3 Date of Service Edit: Clinical

L3702 0 3 Date of Service Edit: Clinical

L3710 0 3 Date of Service Edit: Clinical

L3720 0 3 Date of Service Edit: Clinical

L3730 0 3 Date of Service Edit: Clinical

L3740 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL3760 0 3 Date of Service Edit: Clinical

L3762 0 3 Date of Service Edit: Clinical

L3763 0 3 Date of Service Edit: Clinical

L3764 0 3 Date of Service Edit: Clinical

L3765 0 3 Date of Service Edit: Clinical

L3766 0 3 Date of Service Edit: Clinical

L3806 0 3 Date of Service Edit: Clinical

L3807 0 3 Date of Service Edit: Clinical

L3808 0 3 Date of Service Edit: Clinical

L3809 0 3 Date of Service Edit: Clinical

L3900 0 3 Date of Service Edit: Clinical

L3901 0 3 Date of Service Edit: Clinical

L3904 0 3 Date of Service Edit: Clinical

L3905 0 3 Date of Service Edit: Clinical

L3906 0 3 Date of Service Edit: Clinical

L3908 0 3 Date of Service Edit: Clinical

L3912 0 3 Date of Service Edit: Clinical

L3913 0 3 Date of Service Edit: Clinical

L3915 0 3 Date of Service Edit: Clinical

L3916 0 3 Date of Service Edit: Clinical

L3917 0 3 Date of Service Edit: Clinical

L3918 0 3 Date of Service Edit: Clinical

L3919 0 3 Date of Service Edit: Clinical

L3921 0 3 Date of Service Edit: Clinical

L3923 0 3 Date of Service Edit: Clinical

L3924 0 3 Date of Service Edit: Clinical

L3925 0 3 Date of Service Edit: Clinical

L3927 0 3 Date of Service Edit: Clinical

L3929 0 3 Date of Service Edit: Clinical

L3930 0 3 Date of Service Edit: Clinical

L3931 0 3 Date of Service Edit: Clinical

L3933 0 3 Date of Service Edit: Clinical

L3935 0 3 Date of Service Edit: Clinical

L3956 0 3 Date of Service Edit: Clinical

L3960 0 3 Date of Service Edit: Clinical

L3961 0 3 Date of Service Edit: Clinical

L3962 0 3 Date of Service Edit: Clinical

L3967 0 3 Date of Service Edit: Clinical

L3971 0 3 Date of Service Edit: Clinical

L3973 0 3 Date of Service Edit: Clinical

L3975 0 3 Date of Service Edit: Clinical

L3976 0 3 Date of Service Edit: Clinical

L3977 0 3 Date of Service Edit: Clinical

L3978 0 3 Date of Service Edit: Clinical

27

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL3980 0 3 Date of Service Edit: Clinical

L3981 0 3 Date of Service Edit: Clinical

L3982 0 3 Date of Service Edit: Clinical

L3984 0 3 Date of Service Edit: Clinical

L4000 0 3 Date of Service Edit: Clinical

L4002 0 3 Date of Service Edit: Clinical

L4010 0 3 Date of Service Edit: Clinical

L4020 0 3 Date of Service Edit: Clinical

L4030 0 3 Date of Service Edit: Clinical

L4040 0 3 Date of Service Edit: Clinical

L4045 0 3 Date of Service Edit: Clinical

L4050 0 3 Date of Service Edit: Clinical

L4055 0 3 Date of Service Edit: Clinical

L4060 0 3 Date of Service Edit: Clinical

L4070 0 3 Date of Service Edit: Clinical

L4080 0 3 Date of Service Edit: Clinical

L4090 0 3 Date of Service Edit: Clinical

L4100 0 3 Date of Service Edit: Clinical

L4110 0 3 Date of Service Edit: Clinical

L4130 0 3 Date of Service Edit: Clinical

L4205 0 3 Date of Service Edit: Clinical

L4210 0 3 Date of Service Edit: Clinical

L4350 0 3 Date of Service Edit: Clinical

L4360 0 3 Date of Service Edit: Clinical

L4361 0 3 Date of Service Edit: Clinical

L4370 0 3 Date of Service Edit: Clinical

L4386 0 3 Date of Service Edit: Clinical

L4387 0 3 Date of Service Edit: Clinical

L4392 0 3 Date of Service Edit: Clinical

L4394 0 3 Date of Service Edit: Clinical

L4396 0 3 Date of Service Edit: Clinical

L4397 0 3 Date of Service Edit: Clinical

L4398 0 3 Date of Service Edit: Clinical

L4631 0 3 Date of Service Edit: Clinical

L5000 0 3 Date of Service Edit: Clinical

L5010 0 3 Date of Service Edit: Clinical

L5020 0 3 Date of Service Edit: Clinical

L5050 0 3 Date of Service Edit: Clinical

L5060 0 3 Date of Service Edit: Clinical

L5100 0 3 Date of Service Edit: Clinical

L5105 0 3 Date of Service Edit: Clinical

L5150 0 3 Date of Service Edit: Clinical

L5160 0 3 Date of Service Edit: Clinical

L5200 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL5210 0 3 Date of Service Edit: Clinical

L5220 0 3 Date of Service Edit: Clinical

L5230 0 3 Date of Service Edit: Clinical

L5250 0 3 Date of Service Edit: Clinical

L5270 0 3 Date of Service Edit: Clinical

L5280 0 3 Date of Service Edit: Clinical

L5301 0 3 Date of Service Edit: Clinical

L5312 0 3 Date of Service Edit: Clinical

L5321 0 3 Date of Service Edit: Clinical

L5331 0 3 Date of Service Edit: Clinical

L5341 0 3 Date of Service Edit: Clinical

L5400 0 3 Date of Service Edit: Clinical

L5410 0 3 Date of Service Edit: Clinical

L5420 0 3 Date of Service Edit: Clinical

L5430 0 3 Date of Service Edit: Clinical

L5450 0 3 Date of Service Edit: Clinical

L5460 0 3 Date of Service Edit: Clinical

L5500 0 3 Date of Service Edit: Clinical

L5505 0 3 Date of Service Edit: Clinical

L5510 0 3 Date of Service Edit: Clinical

L5520 0 3 Date of Service Edit: Clinical

L5530 0 3 Date of Service Edit: Clinical

L5535 0 3 Date of Service Edit: Clinical

L5540 0 3 Date of Service Edit: Clinical

L5560 0 3 Date of Service Edit: Clinical

L5570 0 3 Date of Service Edit: Clinical

L5580 0 3 Date of Service Edit: Clinical

L5585 0 3 Date of Service Edit: Clinical

L5590 0 3 Date of Service Edit: Clinical

L5595 0 3 Date of Service Edit: Clinical

L5600 0 3 Date of Service Edit: Clinical

L5610 0 3 Date of Service Edit: Clinical

L5611 0 3 Date of Service Edit: Clinical

L5613 0 3 Date of Service Edit: Clinical

L5614 0 3 Date of Service Edit: Clinical

L5616 0 3 Date of Service Edit: Clinical

L5617 0 3 Date of Service Edit: Clinical

L5618 0 3 Date of Service Edit: Clinical

L5620 0 3 Date of Service Edit: Clinical

L5622 0 3 Date of Service Edit: Clinical

L5624 0 3 Date of Service Edit: Clinical

L5626 0 3 Date of Service Edit: Clinical

L5628 0 3 Date of Service Edit: Clinical

L5629 0 3 Date of Service Edit: Clinical

28

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL5630 0 3 Date of Service Edit: Clinical

L5631 0 3 Date of Service Edit: Clinical

L5632 0 3 Date of Service Edit: Clinical

L5634 0 3 Date of Service Edit: Clinical

L5636 0 3 Date of Service Edit: Clinical

L5637 0 3 Date of Service Edit: Clinical

L5638 0 3 Date of Service Edit: Clinical

L5639 0 3 Date of Service Edit: Clinical

L5640 0 3 Date of Service Edit: Clinical

L5642 0 3 Date of Service Edit: Clinical

L5643 0 3 Date of Service Edit: Clinical

L5644 0 3 Date of Service Edit: Clinical

L5645 0 3 Date of Service Edit: Clinical

L5646 0 3 Date of Service Edit: Clinical

L5647 0 3 Date of Service Edit: Clinical

L5648 0 3 Date of Service Edit: Clinical

L5649 0 3 Date of Service Edit: Clinical

L5650 0 3 Date of Service Edit: Clinical

L5651 0 3 Date of Service Edit: Clinical

L5652 0 3 Date of Service Edit: Clinical

L5653 0 3 Date of Service Edit: Clinical

L5654 0 3 Date of Service Edit: Clinical

L5655 0 3 Date of Service Edit: Clinical

L5656 0 3 Date of Service Edit: Clinical

L5658 0 3 Date of Service Edit: Clinical

L5661 0 3 Date of Service Edit: Clinical

L5665 0 3 Date of Service Edit: Clinical

L5666 0 3 Date of Service Edit: Clinical

L5668 0 3 Date of Service Edit: Clinical

L5670 0 3 Date of Service Edit: Clinical

L5671 0 3 Date of Service Edit: Clinical

L5672 0 3 Date of Service Edit: Clinical

L5673 0 3 Date of Service Edit: Clinical

L5676 0 3 Date of Service Edit: Clinical

L5677 0 3 Date of Service Edit: Clinical

L5678 0 3 Date of Service Edit: Clinical

L5679 0 3 Date of Service Edit: Clinical

L5680 0 3 Date of Service Edit: Clinical

L5681 0 3 Date of Service Edit: Clinical

L5682 0 3 Date of Service Edit: Clinical

L5683 0 3 Date of Service Edit: Clinical

L5684 0 3 Date of Service Edit: Clinical

L5685 0 3 Date of Service Edit: Clinical

L5686 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL5688 0 3 Date of Service Edit: Clinical

L5690 0 3 Date of Service Edit: Clinical

L5692 0 3 Date of Service Edit: Clinical

L5694 0 3 Date of Service Edit: Clinical

L5695 0 3 Date of Service Edit: Clinical

L5696 0 3 Date of Service Edit: Clinical

L5697 0 3 Date of Service Edit: Clinical

L5698 0 3 Date of Service Edit: Clinical

L5699 0 3 Date of Service Edit: Clinical

L5700 0 3 Date of Service Edit: Clinical

L5701 0 3 Date of Service Edit: Clinical

L5702 0 3 Date of Service Edit: Clinical

L5703 0 3 Date of Service Edit: Clinical

L5704 0 3 Date of Service Edit: Clinical

L5705 0 3 Date of Service Edit: Clinical

L5706 0 3 Date of Service Edit: Clinical

L5707 0 3 Date of Service Edit: Clinical

L5710 0 3 Date of Service Edit: Clinical

L5711 0 3 Date of Service Edit: Clinical

L5712 0 3 Date of Service Edit: Clinical

L5714 0 3 Date of Service Edit: Clinical

L5716 0 3 Date of Service Edit: Clinical

L5718 0 3 Date of Service Edit: Clinical

L5722 0 3 Date of Service Edit: Clinical

L5724 0 3 Date of Service Edit: Clinical

L5726 0 3 Date of Service Edit: Clinical

L5728 0 3 Date of Service Edit: Clinical

L5780 0 3 Date of Service Edit: Clinical

L5781 0 3 Date of Service Edit: Clinical

L5782 0 3 Date of Service Edit: Clinical

L5785 0 3 Date of Service Edit: Clinical

L5790 0 3 Date of Service Edit: Clinical

L5795 0 3 Date of Service Edit: Clinical

L5810 0 3 Date of Service Edit: Clinical

L5811 0 3 Date of Service Edit: Clinical

L5812 0 3 Date of Service Edit: Clinical

L5814 0 3 Date of Service Edit: Clinical

L5816 0 3 Date of Service Edit: Clinical

L5818 0 3 Date of Service Edit: Clinical

L5822 0 3 Date of Service Edit: Clinical

L5824 0 3 Date of Service Edit: Clinical

L5826 0 3 Date of Service Edit: Clinical

L5828 0 3 Date of Service Edit: Clinical

L5830 0 3 Date of Service Edit: Clinical

29

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL5840 0 3 Date of Service Edit: Clinical

L5845 0 3 Date of Service Edit: Clinical

L5848 0 3 Date of Service Edit: Clinical

L5850 0 3 Date of Service Edit: Clinical

L5855 0 3 Date of Service Edit: Clinical

L5856 0 3 Date of Service Edit: Clinical

L5857 0 3 Date of Service Edit: Clinical

L5858 0 3 Date of Service Edit: Clinical

L5859 0 3 Date of Service Edit: Clinical

L5910 0 3 Date of Service Edit: Clinical

L5920 0 3 Date of Service Edit: Clinical

L5925 0 3 Date of Service Edit: Clinical

L5930 0 3 Date of Service Edit: Clinical

L5940 0 3 Date of Service Edit: Clinical

L5950 0 3 Date of Service Edit: Clinical

L5960 0 3 Date of Service Edit: Clinical

L5961 0 3 Date of Service Edit: Clinical

L5962 0 3 Date of Service Edit: Clinical

L5964 0 3 Date of Service Edit: Clinical

L5966 0 3 Date of Service Edit: Clinical

L5968 0 3 Date of Service Edit: Clinical

L5969 0 3 Date of Service Edit: Clinical

L5970 0 3 Date of Service Edit: Clinical

L5971 0 3 Date of Service Edit: Clinical

L5972 0 3 Date of Service Edit: Clinical

L5974 0 3 Date of Service Edit: Clinical

L5975 0 3 Date of Service Edit: Clinical

L5976 0 3 Date of Service Edit: Clinical

L5978 0 3 Date of Service Edit: Clinical

L5979 0 3 Date of Service Edit: Clinical

L5980 0 3 Date of Service Edit: Clinical

L5981 0 3 Date of Service Edit: Clinical

L5982 0 3 Date of Service Edit: Clinical

L5984 0 3 Date of Service Edit: Clinical

L5985 0 3 Date of Service Edit: Clinical

L5986 0 3 Date of Service Edit: Clinical

L5987 0 3 Date of Service Edit: Clinical

L5988 0 3 Date of Service Edit: Clinical

L5990 0 3 Date of Service Edit: Clinical

L6000 0 3 Date of Service Edit: Clinical

L6010 0 3 Date of Service Edit: Clinical

L6020 0 3 Date of Service Edit: Clinical

L6026 0 3 Date of Service Edit: Clinical

L6050 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL6055 0 3 Date of Service Edit: Clinical

L6100 0 3 Date of Service Edit: Clinical

L6110 0 3 Date of Service Edit: Clinical

L6120 0 3 Date of Service Edit: Clinical

L6130 0 3 Date of Service Edit: Clinical

L6200 0 3 Date of Service Edit: Clinical

L6205 0 3 Date of Service Edit: Clinical

L6250 0 3 Date of Service Edit: Clinical

L6300 0 3 Date of Service Edit: Clinical

L6310 0 3 Date of Service Edit: Clinical

L6320 0 3 Date of Service Edit: Clinical

L6350 0 3 Date of Service Edit: Clinical

L6360 0 3 Date of Service Edit: Clinical

L6370 0 3 Date of Service Edit: Clinical

L6380 0 3 Date of Service Edit: Clinical

L6382 0 3 Date of Service Edit: Clinical

L6384 0 3 Date of Service Edit: Clinical

L6386 0 3 Date of Service Edit: Clinical

L6388 0 3 Date of Service Edit: Clinical

L6400 0 3 Date of Service Edit: Clinical

L6450 0 3 Date of Service Edit: Clinical

L6500 0 3 Date of Service Edit: Clinical

L6550 0 3 Date of Service Edit: Clinical

L6570 0 3 Date of Service Edit: Clinical

L6580 0 3 Date of Service Edit: Clinical

L6582 0 3 Date of Service Edit: Clinical

L6584 0 3 Date of Service Edit: Clinical

L6586 0 3 Date of Service Edit: Clinical

L6588 0 3 Date of Service Edit: Clinical

L6590 0 3 Date of Service Edit: Clinical

L6600 0 3 Date of Service Edit: Clinical

L6605 0 3 Date of Service Edit: Clinical

L6610 0 3 Date of Service Edit: Clinical

L6611 0 3 Date of Service Edit: Clinical

L6615 0 3 Date of Service Edit: Clinical

L6616 0 3 Date of Service Edit: Clinical

L6620 0 3 Date of Service Edit: Clinical

L6621 0 3 Date of Service Edit: Clinical

L6623 0 3 Date of Service Edit: Clinical

L6624 0 3 Date of Service Edit: Clinical

L6625 0 3 Date of Service Edit: Clinical

L6628 0 3 Date of Service Edit: Clinical

L6629 0 3 Date of Service Edit: Clinical

L6630 0 3 Date of Service Edit: Clinical

30

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL6632 0 3 Date of Service Edit: Clinical

L6635 0 3 Date of Service Edit: Clinical

L6637 0 3 Date of Service Edit: Clinical

L6638 0 3 Date of Service Edit: Clinical

L6640 0 3 Date of Service Edit: Clinical

L6641 0 3 Date of Service Edit: Clinical

L6642 0 3 Date of Service Edit: Clinical

L6645 0 3 Date of Service Edit: Clinical

L6646 0 3 Date of Service Edit: Clinical

L6647 0 3 Date of Service Edit: Clinical

L6648 0 3 Date of Service Edit: Clinical

L6650 0 3 Date of Service Edit: Clinical

L6655 0 3 Date of Service Edit: Clinical

L6660 0 3 Date of Service Edit: Clinical

L6665 0 3 Date of Service Edit: Clinical

L6670 0 3 Date of Service Edit: Clinical

L6672 0 3 Date of Service Edit: Clinical

L6675 0 3 Date of Service Edit: Clinical

L6676 0 3 Date of Service Edit: Clinical

L6677 0 3 Date of Service Edit: Clinical

L6680 0 3 Date of Service Edit: Clinical

L6682 0 3 Date of Service Edit: Clinical

L6684 0 3 Date of Service Edit: Clinical

L6686 0 3 Date of Service Edit: Clinical

L6687 0 3 Date of Service Edit: Clinical

L6688 0 3 Date of Service Edit: Clinical

L6689 0 3 Date of Service Edit: Clinical

L6690 0 3 Date of Service Edit: Clinical

L6691 0 3 Date of Service Edit: Clinical

L6692 0 3 Date of Service Edit: Clinical

L6693 0 3 Date of Service Edit: Clinical

L6694 0 3 Date of Service Edit: Clinical

L6695 0 3 Date of Service Edit: Clinical

L6696 0 3 Date of Service Edit: Clinical

L6697 0 3 Date of Service Edit: Clinical

L6698 0 3 Date of Service Edit: Clinical

L6703 0 3 Date of Service Edit: Clinical

L6704 0 3 Date of Service Edit: Clinical

L6706 0 3 Date of Service Edit: Clinical

L6707 0 3 Date of Service Edit: Clinical

L6708 0 3 Date of Service Edit: Clinical

L6709 0 3 Date of Service Edit: Clinical

L6711 0 3 Date of Service Edit: Clinical

L6712 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL6713 0 3 Date of Service Edit: Clinical

L6714 0 3 Date of Service Edit: Clinical

L6715 0 3 Date of Service Edit: Clinical

L6721 0 3 Date of Service Edit: Clinical

L6722 0 3 Date of Service Edit: Clinical

L6805 0 3 Date of Service Edit: Clinical

L6810 0 3 Date of Service Edit: Clinical

L6880 0 3 Date of Service Edit: Clinical

L6881 0 3 Date of Service Edit: Clinical

L6882 0 3 Date of Service Edit: Clinical

L6883 0 3 Date of Service Edit: Clinical

L6884 0 3 Date of Service Edit: Clinical

L6885 0 3 Date of Service Edit: Clinical

L6890 0 3 Date of Service Edit: Clinical

L6895 0 3 Date of Service Edit: Clinical

L6900 0 3 Date of Service Edit: Clinical

L6905 0 3 Date of Service Edit: Clinical

L6910 0 3 Date of Service Edit: Clinical

L6915 0 3 Date of Service Edit: Clinical

L6920 0 3 Date of Service Edit: Clinical

L6925 0 3 Date of Service Edit: Clinical

L6930 0 3 Date of Service Edit: Clinical

L6935 0 3 Date of Service Edit: Clinical

L6940 0 3 Date of Service Edit: Clinical

L6945 0 3 Date of Service Edit: Clinical

L6950 0 3 Date of Service Edit: Clinical

L6955 0 3 Date of Service Edit: Clinical

L6960 0 3 Date of Service Edit: Clinical

L6965 0 3 Date of Service Edit: Clinical

L6970 0 3 Date of Service Edit: Clinical

L6975 0 3 Date of Service Edit: Clinical

L7007 0 3 Date of Service Edit: Clinical

L7008 0 3 Date of Service Edit: Clinical

L7009 0 3 Date of Service Edit: Clinical

L7040 0 3 Date of Service Edit: Clinical

L7045 0 3 Date of Service Edit: Clinical

L7170 0 3 Date of Service Edit: Clinical

L7180 0 3 Date of Service Edit: Clinical

L7181 0 3 Date of Service Edit: Clinical

L7185 0 3 Date of Service Edit: Clinical

L7186 0 3 Date of Service Edit: Clinical

L7190 0 3 Date of Service Edit: Clinical

L7191 0 3 Date of Service Edit: Clinical

L7259 0 3 Date of Service Edit: Clinical

31

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL7360 0 3 Date of Service Edit: Clinical

L7362 0 3 Date of Service Edit: Clinical

L7364 0 3 Date of Service Edit: Clinical

L7366 0 3 Date of Service Edit: Clinical

L7367 0 3 Date of Service Edit: Clinical

L7368 0 3 Date of Service Edit: Clinical

L7400 0 3 Date of Service Edit: Clinical

L7401 0 3 Date of Service Edit: Clinical

L7402 0 3 Date of Service Edit: Clinical

L7403 0 3 Date of Service Edit: Clinical

L7404 0 3 Date of Service Edit: Clinical

L7405 0 3 Date of Service Edit: Clinical

L7510 4 3 Date of Service Edit: Clinical

L7900 0 3 Date of Service Edit: Clinical

L7902 0 3 Date of Service Edit: Clinical

L8000 0 3 Date of Service Edit: Clinical

L8001 0 3 Date of Service Edit: Clinical

L8002 0 3 Date of Service Edit: Clinical

L8015 0 3 Date of Service Edit: Clinical

L8020 0 3 Date of Service Edit: Clinical

L8030 0 3 Date of Service Edit: Clinical

L8031 0 3 Date of Service Edit: Clinical

L8032 0 3 Date of Service Edit: Clinical

L8035 0 3 Date of Service Edit: Clinical

L8039 0 3 Date of Service Edit: Clinical

L8040 0 3 Date of Service Edit: Clinical

L8041 0 3 Date of Service Edit: Clinical

L8042 0 3 Date of Service Edit: Clinical

L8043 0 3 Date of Service Edit: Clinical

L8044 0 3 Date of Service Edit: Clinical

L8045 0 3 Date of Service Edit: Clinical

L8046 0 3 Date of Service Edit: Clinical

L8047 0 3 Date of Service Edit: Clinical

L8048 1 3 Date of Service Edit: Clinical

L8049 0 3 Date of Service Edit: Clinical

L8300 0 3 Date of Service Edit: Clinical

L8310 0 3 Date of Service Edit: Clinical

L8320 0 3 Date of Service Edit: Clinical

L8330 0 3 Date of Service Edit: Clinical

L8400 0 3 Date of Service Edit: Clinical

L8410 0 3 Date of Service Edit: Clinical

L8415 0 3 Date of Service Edit: Clinical

L8417 0 3 Date of Service Edit: Clinical

L8420 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL8430 0 3 Date of Service Edit: Clinical

L8435 0 3 Date of Service Edit: Clinical

L8440 0 3 Date of Service Edit: Clinical

L8460 0 3 Date of Service Edit: Clinical

L8465 0 3 Date of Service Edit: Clinical

L8470 0 3 Date of Service Edit: Clinical

L8480 0 3 Date of Service Edit: Clinical

L8485 0 3 Date of Service Edit: Clinical

L8500 0 3 Date of Service Edit: Clinical

L8501 0 3 Date of Service Edit: Clinical

L8507 0 3 Date of Service Edit: Clinical

L8509 1 1 Line Edit

L8510 0 3 Date of Service Edit: Clinical

L8511 1 1 Line Edit

L8514 1 1 Line Edit

L8515 1 1 Line Edit

L8600 2 1 Line Edit

L8604 3 3 Date of Service Edit: Clinical

L8605 4 3 Date of Service Edit: Clinical

L8606 5 3 Date of Service Edit: Clinical

L8607 20 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

32

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorL8682 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

L8696 1 3 Date of Service Edit: Clinical

P2028 1 3 Date of Service Edit: Clinical

P2029 1 3 Date of Service Edit: Clinical

P2033 1 3 Date of Service Edit: Clinical

P2038 1 3 Date of Service Edit: Clinical

P3000 1 3 Date of Service Edit: Clinical

P3001 1 3 Date of Service Edit: Clinical

P9010 2 3 Date of Service Edit: Clinical

P9011 2 3 Date of Service Edit: Clinical

P9012 8 3 Date of Service Edit: Clinical

P9016 3 3 Date of Service Edit: Clinical

P9017 2 3 Date of Service Edit: Clinical

P9019 2 3 Date of Service Edit: Clinical

P9020 2 3 Date of Service Edit: Clinical

P9021 3 3 Date of Service Edit: Clinical

P9022 2 3 Date of Service Edit: Clinical

P9023 2 3 Date of Service Edit: Clinical

P9031 12 3 Date of Service Edit: Clinical

P9032 12 3 Date of Service Edit: Clinical

P9033 12 3 Date of Service Edit: Clinical

P9034 2 3 Date of Service Edit: Clinical

P9035 2 3 Date of Service Edit: Clinical

P9036 2 3 Date of Service Edit: Clinical

P9037 2 3 Date of Service Edit: Clinical

P9038 2 3 Date of Service Edit: Clinical

P9039 2 3 Date of Service Edit: Clinical

P9040 3 3 Date of Service Edit: Clinical

P9041 5 3 Date of Service Edit: Clinical

P9043 5 3 Date of Service Edit: Clinical

P9044 10 3 Date of Service Edit: Clinical

P9045 20 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorP9046 25 3 Date of Service Edit: Clinical

P9047 20 3 Date of Service Edit: Clinical

P9048 1 3 Date of Service Edit: Clinical

P9050 1 3 Date of Service Edit: Clinical

P9051 2 3 Date of Service Edit: Clinical

P9052 2 3 Date of Service Edit: Clinical

P9053 2 3 Date of Service Edit: Clinical

P9054 2 3 Date of Service Edit: Clinical

P9055 2 3 Date of Service Edit: Clinical

P9056 2 3 Date of Service Edit: Clinical

P9057 2 3 Date of Service Edit: Clinical

P9058 2 3 Date of Service Edit: Clinical

P9059 2 3 Date of Service Edit: Clinical

P9060 2 3 Date of Service Edit: Clinical

P9070 2 1 Line Edit

P9071 2 1 Line Edit

P9072 2 1 Line Edit

P9603 300 3 Date of Service Edit: Clinical

P9604 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

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

Q0138 510 3 Date of Service Edit: Clinical

Q0139 510 3 Date of Service Edit: Clinical

Q0144 0 3 Date of Service Edit: Clinical

Q0161 0 3 Date of Service Edit: Clinical

Q0162 0 3 Date of Service Edit: Clinical

Q0163 0 3 Date of Service Edit: Clinical

Q0164 0 3 Date of Service Edit: Clinical

Q0166 0 3 Date of Service Edit: Clinical

Q0167 0 3 Date of Service Edit: Clinical

Q0169 0 3 Date of Service Edit: Clinical

Q0173 0 3 Date of Service Edit: Clinical

Q0174 0 3 Date of Service Edit: Clinical

Q0175 0 3 Date of Service Edit: Clinical

Q0177 0 3 Date of Service Edit: Clinical

Q0180 0 3 Date of Service Edit: Clinical

Q0478 1 1 Line Edit

33

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorQ0479 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

Q0501 1 1 Line Edit

Q0502 1 1 Line Edit

Q0503 3 1 Line Edit

Q0504 1 1 Line Edit

Q0506 8 3 Date of Service Edit: Clinical

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 0 3 Date of Service Edit: Clinical

Q0511 0 3 Date of Service Edit: Clinical

Q0512 0 3 Date of Service Edit: Clinical

Q0513 0 3 Date of Service Edit: Clinical

Q0514 0 3 Date of Service Edit: Clinical

Q0515 0 3 Date of Service Edit: Clinical

Q1004 2 1 Line Edit

Q1005 2 1 Line Edit

Q2004 1 3 Date of Service Edit: Clinical

Q2009 100 3 Date of Service Edit: Clinical

Q2017 12 3 Date of Service Edit: Clinical

Q2026 45 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

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorQ2037 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

Q2049 14 3 Date of Service Edit: Clinical

Q2050 14 3 Date of Service Edit: Clinical

Q2052 1 3 Date of Service Edit: Clinical

Q3014 1 3 Date of Service Edit: Clinical

Q3027 30 3 Date of Service Edit: Clinical

Q3028 0 3 Date of Service Edit: Clinical

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 3 3 Date of Service Edit: Clinical

Q4081 100 3 Date of Service Edit: Clinical

Q4101 88 3 Date of Service Edit: Clinical

Q4102 21 3 Date of Service Edit: Clinical

Q4103 0 3 Date of Service Edit: Clinical

Q4104 50 3 Date of Service Edit: Clinical

Q4105 250 3 Date of Service Edit: Clinical

Q4106 76 3 Date of Service Edit: Clinical

Q4107 50 3 Date of Service Edit: Clinical

Q4108 250 3 Date of Service Edit: Clinical

Q4110 250 3 Date of Service Edit: Clinical

Q4111 56 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 192 3 Date of Service Edit: Clinical

Q4117 200 3 Date of Service Edit: Clinical

Q4118 1000 3 Date of Service Edit: Clinical

Q4119 150 3 Date of Service Edit: Clinical

Q4120 50 3 Date of Service Edit: Clinical

Q4121 78 3 Date of Service Edit: Clinical

Q4122 96 3 Date of Service Edit: Clinical

Q4123 160 3 Date of Service Edit: Clinical

Q4124 140 3 Date of Service Edit: Clinical

Q4125 28 3 Date of Service Edit: Clinical

34

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorQ4126 32 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 60 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

Q4137 32 1 Line Edit

Q4138 32 1 Line Edit

Q4139 2 3 Date of Service Edit: Clinical

Q4140 32 1 Line Edit

Q4141 25 1 Line Edit

Q4142 600 1 Line Edit

Q4143 96 1 Line Edit

Q4145 160 1 Line Edit

Q4146 50 1 Line Edit

Q4147 150 1 Line Edit

Q4148 18 1 Line Edit

Q4149 10 1 Line Edit

Q4150 32 1 Line Edit

Q4151 24 1 Line Edit

Q4152 24 1 Line Edit

Q4153 6 1 Line Edit

Q4154 36 1 Line Edit

Q4155 100 1 Line Edit

Q4156 49 1 Line Edit

Q4157 24 1 Line Edit

Q4158 70 1 Line Edit

Q4159 7 1 Line Edit

Q4160 36 1 Line Edit

Q4161 42 1 Line Edit

Q4162 4 1 Line Edit

Q4163 32 1 Line Edit

Q4164 400 1 Line Edit

Q4165 100 1 Line Edit

Q5101 3360 3 Date of Service Edit: Clinical

Q9950 5 3 Date of Service Edit: Clinical

Q9951 0 3 Date of Service Edit: Clinical

Q9953 10 3 Date of Service Edit: Clinical

Q9954 18 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorQ9955 10 2 Date of Service Edit: Policy

Q9956 9 3 Date of Service Edit: Clinical

Q9957 3 3 Date of Service Edit: Clinical

Q9958 300 3 Date of Service Edit: Clinical

Q9959 0 3 Date of Service Edit: Clinical

Q9960 250 3 Date of Service Edit: Clinical

Q9961 200 3 Date of Service Edit: Clinical

Q9962 150 3 Date of Service Edit: Clinical

Q9963 240 3 Date of Service Edit: Clinical

Q9964 0 3 Date of Service Edit: Clinical

Q9966 250 3 Date of Service Edit: Clinical

Q9967 300 3 Date of Service Edit: Clinical

Q9969 3 1 Line Edit

Q9980 50 3 Date of Service Edit: Clinical

R0070 2 3 Date of Service Edit: Clinical

R0075 2 3 Date of Service Edit: Clinical

V2020 0 3 Date of Service Edit: Clinical

V2025 0 3 Date of Service Edit: Clinical

V2100 0 3 Date of Service Edit: Clinical

V2101 0 3 Date of Service Edit: Clinical

V2102 0 3 Date of Service Edit: Clinical

V2103 0 3 Date of Service Edit: Clinical

V2104 0 3 Date of Service Edit: Clinical

V2105 0 3 Date of Service Edit: Clinical

V2106 0 3 Date of Service Edit: Clinical

V2107 0 3 Date of Service Edit: Clinical

V2108 0 3 Date of Service Edit: Clinical

V2109 0 3 Date of Service Edit: Clinical

V2110 0 3 Date of Service Edit: Clinical

V2111 0 3 Date of Service Edit: Clinical

V2112 0 3 Date of Service Edit: Clinical

V2113 0 3 Date of Service Edit: Clinical

V2114 0 3 Date of Service Edit: Clinical

V2115 0 3 Date of Service Edit: Clinical

V2118 0 3 Date of Service Edit: Clinical

V2121 0 3 Date of Service Edit: Clinical

V2199 2 3 Date of Service Edit: Clinical

V2200 0 3 Date of Service Edit: Clinical

V2201 0 3 Date of Service Edit: Clinical

V2202 0 3 Date of Service Edit: Clinical

V2203 0 3 Date of Service Edit: Clinical

V2204 0 3 Date of Service Edit: Clinical

V2205 0 3 Date of Service Edit: Clinical

V2206 0 3 Date of Service Edit: Clinical

35

2017 HCPCS: LEVEL II NATIONAL CODES20

17 P

RA

CTIT

ION

ER/D

ME

MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorV2207 0 3 Date of Service Edit: Clinical

V2208 0 3 Date of Service Edit: Clinical

V2209 0 3 Date of Service Edit: Clinical

V2210 0 3 Date of Service Edit: Clinical

V2211 0 3 Date of Service Edit: Clinical

V2212 0 3 Date of Service Edit: Clinical

V2213 0 3 Date of Service Edit: Clinical

V2214 0 3 Date of Service Edit: Clinical

V2215 0 3 Date of Service Edit: Clinical

V2218 0 3 Date of Service Edit: Clinical

V2219 0 3 Date of Service Edit: Clinical

V2220 0 3 Date of Service Edit: Clinical

V2221 0 3 Date of Service Edit: Clinical

V2299 0 3 Date of Service Edit: Clinical

V2300 0 3 Date of Service Edit: Clinical

V2301 0 3 Date of Service Edit: Clinical

V2302 0 3 Date of Service Edit: Clinical

V2303 0 3 Date of Service Edit: Clinical

V2304 0 3 Date of Service Edit: Clinical

V2305 0 3 Date of Service Edit: Clinical

V2306 0 3 Date of Service Edit: Clinical

V2307 0 3 Date of Service Edit: Clinical

V2308 0 3 Date of Service Edit: Clinical

V2309 0 3 Date of Service Edit: Clinical

V2310 0 3 Date of Service Edit: Clinical

V2311 0 3 Date of Service Edit: Clinical

V2312 0 3 Date of Service Edit: Clinical

V2313 0 3 Date of Service Edit: Clinical

V2314 0 3 Date of Service Edit: Clinical

V2315 0 3 Date of Service Edit: Clinical

V2318 0 3 Date of Service Edit: Clinical

V2319 0 3 Date of Service Edit: Clinical

V2320 0 3 Date of Service Edit: Clinical

V2321 0 3 Date of Service Edit: Clinical

V2399 0 3 Date of Service Edit: Clinical

V2410 0 3 Date of Service Edit: Clinical

V2430 0 3 Date of Service Edit: Clinical

V2499 2 3 Date of Service Edit: Clinical

V2500 0 3 Date of Service Edit: Clinical

V2501 0 3 Date of Service Edit: Clinical

V2502 0 3 Date of Service Edit: Clinical

V2503 0 3 Date of Service Edit: Clinical

V2510 0 3 Date of Service Edit: Clinical

V2511 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorV2512 0 3 Date of Service Edit: Clinical

V2513 0 3 Date of Service Edit: Clinical

V2520 2 1 Line Edit

V2521 2 1 Line Edit

V2522 2 1 Line Edit

V2523 2 1 Line Edit

V2530 0 3 Date of Service Edit: Clinical

V2531 0 3 Date of Service Edit: Clinical

V2599 2 3 Date of Service Edit: Clinical

V2600 0 3 Date of Service Edit: Clinical

V2610 0 3 Date of Service Edit: Clinical

V2615 0 3 Date of Service Edit: Clinical

V2623 0 3 Date of Service Edit: Clinical

V2624 0 3 Date of Service Edit: Clinical

V2625 0 3 Date of Service Edit: Clinical

V2626 0 3 Date of Service Edit: Clinical

V2627 0 3 Date of Service Edit: Clinical

V2628 0 3 Date of Service Edit: Clinical

V2629 0 3 Date of Service Edit: Clinical

V2630 2 1 Line Edit

V2631 2 1 Line Edit

V2632 2 1 Line Edit

V2700 0 3 Date of Service Edit: Clinical

V2702 0 3 Date of Service Edit: Clinical

V2710 0 3 Date of Service Edit: Clinical

V2715 0 3 Date of Service Edit: Clinical

V2718 0 3 Date of Service Edit: Clinical

V2730 0 3 Date of Service Edit: Clinical

V2744 0 3 Date of Service Edit: Clinical

V2745 0 3 Date of Service Edit: Clinical

V2750 0 3 Date of Service Edit: Clinical

V2755 0 3 Date of Service Edit: Clinical

V2756 0 3 Date of Service Edit: Clinical

V2760 0 3 Date of Service Edit: Clinical

V2761 0 3 Date of Service Edit: Clinical

V2762 0 3 Date of Service Edit: Clinical

V2770 0 3 Date of Service Edit: Clinical

V2780 0 3 Date of Service Edit: Clinical

V2781 0 3 Date of Service Edit: Clinical

V2782 0 3 Date of Service Edit: Clinical

V2783 0 3 Date of Service Edit: Clinical

V2784 0 3 Date of Service Edit: Clinical

V2785 2 1 Line Edit

V2786 0 3 Date of Service Edit: Clinical

36

PRACTITIONER EDITS2017 PR

ACTITIO

NER

/DM

E MU

E

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorV5282 0 3 Date of Service Edit: Clinical

V5284 0 3 Date of Service Edit: Clinical

V5285 0 3 Date of Service Edit: Clinical

V5286 0 3 Date of Service Edit: Clinical

V5287 0 3 Date of Service Edit: Clinical

V5288 0 3 Date of Service Edit: Clinical

V5289 0 3 Date of Service Edit: Clinical

HCPCS/CPT Code

Practitioner Services

MUE ValuesMUE Adjudication

IndicatorV2790 1 1 Line Edit

V2797 0 3 Date of Service Edit: Clinical

V5008 0 1 Line Edit

V5010 0 1 Line Edit

V5011 0 1 Line Edit

V5274 0 3 Date of Service Edit: Clinical

V5281 0 3 Date of Service Edit: Clinical