Friday, June 11, 2010

MTUS indicator of CMS 1500

Methodology for Coding Number of Services, MTUS Count and MTUS Indicator Fields

The following instructions should be used as a guide for coding the number of services, MTUS Count and MTUS Indicator fields on the Part B Physician/Supplier Claim. These fields are documented in the CMS National Claims History Data Dictionary as CWFB_SRVC_CNT, CWFB_MTUS_CNT, and CWFB_MTUS_IND_CD, respectively.

Services not falling into examples B, C, E, or F should be coded as shown in example D (services/pricing units).

A. No Allowed Services – (CWFB_MTUS_IND_CD = 0)

For claims reporting no allowed services, the following example should be used to code the line item:
A total of 2 visits was reported for HCPCS code 99211: Office or other outpatient visit for the management of an established patient. Both services were denied.
Number of services: 2 (furnished)
                              MTUS (services): 0 (allowed)
                              MTUS indicator: 0

B. Ambulance Miles - (CWFB_MTUS_IND_CD = 1)

For claims reporting ambulance miles, the following example should be used to code the line item:
Mileage Reporting: A total of 10 miles (1 trip) was reported for HCPCS code A0425: Ground mileage, per statute mile.
                          Number of services: 10
                          MTUS (miles): 10
                         MTUS indicator: 1

C. Anesthesia Time Units - (CWFB_MTUS_IND_CD = 2)

For claims reporting anesthesia time units in 15-minute periods or fractions of 15-minute periods, the following example should be used to code the line item:
A total of 1 allowed service is reported for HCPCS code 00142: Anesthesia for procedures on eye; lens surgery. The anesthesiologist attended the patient for 35 minutes.
                   Number of services: 1
                  MTUS (time units): 23 (one decimal point implied) *
                  MTUS indicator: 2
* Two 15-minute periods + 1/3 of a 15-minute period equals 2.3

D. Services/Pricing Units - (CWFB_MTUS_IND_CD = 3)

For claims reporting a service or pricing unit, the following examples should be used to code the line item:

Example 1-A total of 2 visits was reported for HCPCS code 99211: Office or other outpatient visit for the management of an established patient.
                   Number of services: 2
                   MTUS (services): 2
                   MTUS indicator: 3

Example 2 - A total of 500 milligrams was administered for HCPCS code J0120: Injection, Tetracycline, up to 250 mg.
NOTE: The number of milligrams should not be reported in the service or MTUS fields. Instead, report the number of pricing units. In this case, up to 250 mg equals 1 unit/service. Thus, 500 mg equals 2 units/services.
                    Number of services: 2
                    MTUS (services): 2
                    MTUS indicator: 3

Example 3-A total of 24 cans was purchased, each containing 300 calories for HCPCS code B4150: Enteral Formulae, 100 calories.
NOTE: Neither number of cans nor the number of calories should be reported in the services or MTUS fields. Instead, report the number of pricing units. In this case, 100 calories equals 1 unit/service. Thus, 24 cans * 300 calories / 100 calories equals 72 units/services.
                         Number of services: 72
                        MTUS (services): 72
                        MTUS indicator: 3


E. Oxygen Services - (CWFB_MTUS_IND_CD = 4)

For claims reporting oxygen units, the following example should be used to code the line item:
A total of 2 allowed services was reported for HCPCS code E0441: Oxygen contents, gaseous, 1 month’s supply = 1 unit. The claim reported a 2 month’s supply of oxygen.
                               Number of services: 2
                               MTUS: 2
                               MTUS indicator: 4

F. Blood Services - (CWFB_MTUS_IND_CD = 5)
For claims reporting blood units, the following example should be used to code the line item:
A total of 6 units of blood (services) was furnished for HCPCS code P9010: Blood (whole), for transfusion, per unit. Two units were denied.
                            Number of services: 6 (furnished)
                            MTUS (units): 4 (allowed)
                            MTUS indicator: 5

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