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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, Physicians must report services correctly. This manual discusses general coding principles in Chapter I, and principles more relevant to other specific groups of HCPCS/CPT codes in the other chapters. There are certain types of improper coding that physicians must avoid. All practitioner claims submitted to MACs, outpatient facility services claims (Type of Bill 13X, 14X, 85X), and supplier claims submitted to Durable Medical Equipment (DME) MACs are tested against MUEs. MUEs for HCPCS codes with an MAI of "2" are absolute date of service edits. These are 3per 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 subregulatory guidance. This subregulatory 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. 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). ii. If the bilateral surgery indicator is "1" a bilateral surgical procedure must be reported with "1" unit of service and modifier 50 (bilateral modifier). You can find this guidance in the National Correct Coding Initiative Chapter 1, A. Introduction and V. Medically Unlikely Edits (MUEs). Medicare guidance says, CPT codes 64400-64530 describe injection of anesthetic agent for diagnostic or therapeutic purposes, the codes being distinguished from one another by the named nerve and whether a single or continuous infusion by catheter is used. All injections into the nerve including branches described (named) by the code descriptor at a single patient encounter constitute a single unit of service. You can find this guidance in the National Correct Coding Initiative Chapter 8, H. Medically Unlikely Edits (MUEs).   Medicare guidance says, CMS National Correct Coding Initiative Program (NCCI) Medicare and Medicaid Program. Medically Unlikely Edits (MUEs) are used by the Medicare Administrative Contractors (MACs), including Durable Medical Equipment (DME) MACs, to reduce the improper payment rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. Not all HCPCS/CPT codes have an MUE. You can find this guidance in the CMS.Gov Medically Unlikely Edits.  If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.