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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. 
 
The rules say that providers/suppliers must report services correctly. Procedures should be reported with the 
Current Procedural Terminology (CPT) code that describes the services performed. You can find this rule in 
the Centers for Medicare and Medicaid Services, Medicare National Correct Coding Initiative Policy Manual 
for Medicare Services, Chapter I(A). 
 
The rules say that 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 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 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 National Correct Coding Initiative Chapter 1, A. Introduction and V. 
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. 
 
Medicare guidance says CPT code 19357 has Practitioner Services MUE Value: 1 and MUE Adjudication 
Indicator: 2 Date of Service Edit: Policy. You can find this guidance in the MCR MUE Practitioner Services 
Effective 04-01-2021: Medicare guidance says CPT code 19357 has a Bilateral Surgery Indicator of 1. You 
can find this guidance in the 2021 National Physician Fee Schedule July Release 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.