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 The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101.  Medicare guidance says CPT code 49507- RT and CPT code 49507- LT has a bilateral surgery indicator of "1". You can find this guidance in the 2020 National Physician Fee Schedule Relative Value October Release. Medicare guidance says 1 = 150 percent payment adjustment for bilateral procedures applies. If code is billed with the bilateral modifier base payment for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides, or (b) 150 percent of the fee schedule amount for a single code. If code is reported as a bilateral procedure and is reported with other procedure codes on the same day, apply the bilateral adjustment before applying any applicable multiple procedure rules. You can find this guidance in the Medicare Claims Processing Manual Chapter 23 - Fee Schedule Administration and Coding Requirements, Section 50.6.  Medicare guidance says MUEs for HCPCS codes with an MAI of "2" are absolute date of service edits. These are "per day edits based on policy". HCPCS codes with an MAI of "2" have been rigorously reviewed and vetted within CMS and obtain this MAI designation because UOS on the same date of service Medicare guidance says MUEs for HCPCS codes with an MAI of "2" are absolute date of service edits. These are "per day edits based on policy". HCPCS codes with an MAI of "2" have been rigorously reviewed and vetted within CMS and obtain this MAI designation because UOS on the same date of service (DOS) in excess of the MUE value would be considered impossible because it was contrary to statute, regulation, or sub regulatory guidance. This sub regulatory guidance includes clear correct coding policy that is binding on both providers and CMS claims processing contractors. Limitations created by anatomical, or coding limitations are incorporated in correct coding policy, both in the HIPAA mandated coding descriptors and CMS approved coding guidance as well as specific guidance in CMS and NCCI manuals. For example, it would be contrary to correct coding policy to report more than one unit of service for CPT 94002(Ventilation assist and management . . . initial day) because such use could not accurately describe two initial days of management occurring on the same date of service as would be required by the code descriptor.   As a result, claims processing contractors are instructed that an MAI of "2" denotes a claims processing restriction for which override during processing, reopening, or redetermination would be contrary to CMS policy.  Medicare guidance says 1 = 150 percent payment adjustment for bilateral procedures applies. If code is billed with the bilateral modifier base payment for these codes when reported as bilateral procedures on the lower of: (a) the total actual charge for both sides, or (b) 150 percent of the fee schedule amount for a single code. If code is reported as a bilateral procedure and is reported with other procedure codes on the same day, apply the bilateral adjustment before applying any applicable multiple procedure rules. Both the MAI and MUE value for each HCPCS/CPT code are based on one or more of the following criteria: (3) Edits based on established CMS policies may limit UOS. For example, a) The MUE value for a surgical or diagnostic procedure may be based on the bilateral surgery indicator on the Medicare Physician Fee Schedule Database (MPFSDB). i. If the bilateral surgery indicator is a bilateral procedure must be reported with 1 unit of service. There is no additional payment for the code if reported as a unilateral or bilateral procedure because of anatomy or physiology. Alternatively, the code descriptor may specifically state that the procedure is a unilateral procedure, and there is a separate code for a bilateral procedure ii. If the bilateral surgery indicator is a bilateral surgical procedure must be reported with 1 unit of service and modifier 50 (bilateral modifier). A bilateral diagnostic procedure may be reported with 2 UOS on one claim line, 1 unit of service and modifier 50 on one claim line, or 1 unit of service with modifier RT on one claim line plus 1 unit of service and modifier LT on a second claim line.  iii. If the bilateral surgery indicator is 2 a bilateral procedure must be reported with 1 unit of service. The procedure is priced as a bilateral procedure because (1) the code descriptor defines the procedure as bilateral; (2) the code descriptor states that the procedure is performed unilaterally or bilaterally; or (3) the procedure is usually performed as a bilateral procedure. iv. If the bilateral surgery indicator is 3 a bilateral surgical procedure must be reported with 1 unit of service and modifier 50 (bilateral modifier). A bilateral diagnostic procedure may be reported with 2 UOS on one claim line, 1 unit of service and modifier 50 on one claim line, or 1 unit of service with modifier RT on one claim line plus 1 unit of service and modifier LT on a second claim line .b) The MUE value for a code may be 1 where the code descriptor does not specify a unit of service and CMS considers the default UOS to be per day c) The MUE value for a code may be 0 because the code is listed as invalid, not covered, bundled, not separately payable, statutorily excluded, not reasonable and necessary, etc. based on i. The Medicare Physician Fee Schedule Database ii. Outpatient Prospective Payment System Addendum B iii. Alpha-Numeric HCPCS Code File iv. DMEPOS Jurisdiction List v. Medicare Internet-Only Manual. You can find the guidance in the National Correct Coding Initiative Policy, Chapter I - General Correct Coding Policies, Sec-V- Medically Unlikely Edits.  If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.