Day Frequency Edits Pro

The Day Frequency Edits Pro reimbursement tool applies day frequency limits determined by the payor to the CPT and HCPCS codes listed in the MFD (Maximum Frequency Per Day) schedules. Use the Day Frequency Edits Pro reimbursement tool to limit the number of procedures performed per day according to the procedure lookup table for your facility.

The following table describes the fields on the Day Frequency Edits Pro reimbursement tool.

Field

Description

Use CMS MUE Edits

Applies the CMS Medical Unlikely Edits (MUE) logic to the term.

Note: When this option is selected, the Edits field and Literal Matching check box are disabled.

Edits

Applies day frequency limits to the CPT and HCPCS codes listed in the selected MFD (Maximum Frequency Per Day) schedule.

Literal Matching

Determines if the codes and modifiers must match the selected MFD schedule to apply the edits.

  • When this check box is selected, the codes and modifiers must match the selected MFD schedule to apply the edits.
  • When this check box is NOT selected, the codes must match the selected MFD schedule to apply the edits but only modifiers TC and 26 are evaluated as literal matches. All other modifiers are ignored.

Note: This check box is selected by default.