Daily Max Units Regardless of Modifier

According to the American Medical Association’s (AMA’s) CPT Manual and the Healthcare Common Procedure Coding System (HCPCS) Level II Manual, the CPT code descriptors for certain procedures indicate that the procedure may account for either one or multiples at the same site or for the same condition. It is inappropriate for providers to bill these procedures more than once per day or with units of service greater than one. On this basis, use of distinct services modifiers does not allow additional services. Therefore, if the units of service billed are greater than one, the units will be adjusted to allow only one unit per date of service and all subsequent units will be denied.

Example:

CPT code 11055 is defined as paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion. CPT code 11056 is defined as two to four lesions. CPT code 11057 is defined as more than four lesions.

Additional units of any of these example codes would not be appropriate based on the CPT code definitions and the existence of the other CPT codes in the series.