©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
CPB Billing Regulations Exam Study
Guide Solutions
Medically Unlikely Edits (MUEs) - ANSWER✔✔-number of units that can be reported for a service or
procedure on the same day
Medicare and Medicaid - ANSWER✔✔-Medicare pays first, and Medicaid pays last.
Medicare and TRICARE - ANSWER✔✔-TRICARE is secondary
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) - ANSWER✔✔-Screening Services/
Vision Services/ Dental Services/ Hearing Services/ Other necessary healthcare services/ Diagnostic
services/ Treatment
Prior Authorization - ANSWER✔✔-reported in Item 23;
Patient's name (as it appears on the insurance card)
Patient's date of birth
Insured's ID number
Page 1/8
, ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
CPT®/HCPCS Level II code(s)
ICD-10-CM code(s)
Location where service is performed
Ordering physician
Date of service for the procedure if scheduled
incident-to - ANSWER✔✔-submit claim under the supervising physician
"those services that are furnished incident-to physician professional services in the physician's office
(whether located in a separate office suite or within an institution) or in a patient's home"
global package for surgical procedures - ANSWER✔✔-0-90 days as determined by the health plan:
Local infiltration, digital block, or topical anesthesia;
Writing Orders;
treatment in operation room;
postoperative follow-up care
global days - ANSWER✔✔-major surgeries - 90 days,
Page 2/8
FIRST PUBLISH OCTOBER 2024
CPB Billing Regulations Exam Study
Guide Solutions
Medically Unlikely Edits (MUEs) - ANSWER✔✔-number of units that can be reported for a service or
procedure on the same day
Medicare and Medicaid - ANSWER✔✔-Medicare pays first, and Medicaid pays last.
Medicare and TRICARE - ANSWER✔✔-TRICARE is secondary
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) - ANSWER✔✔-Screening Services/
Vision Services/ Dental Services/ Hearing Services/ Other necessary healthcare services/ Diagnostic
services/ Treatment
Prior Authorization - ANSWER✔✔-reported in Item 23;
Patient's name (as it appears on the insurance card)
Patient's date of birth
Insured's ID number
Page 1/8
, ©EMILLECT 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
CPT®/HCPCS Level II code(s)
ICD-10-CM code(s)
Location where service is performed
Ordering physician
Date of service for the procedure if scheduled
incident-to - ANSWER✔✔-submit claim under the supervising physician
"those services that are furnished incident-to physician professional services in the physician's office
(whether located in a separate office suite or within an institution) or in a patient's home"
global package for surgical procedures - ANSWER✔✔-0-90 days as determined by the health plan:
Local infiltration, digital block, or topical anesthesia;
Writing Orders;
treatment in operation room;
postoperative follow-up care
global days - ANSWER✔✔-major surgeries - 90 days,
Page 2/8
