MEDICALLY UNLIKELY EDITS (MUEs)
To lower the Medicare fee-for-service paid claims error rate, CMS established units of service edits referred to as Medically Unlikely Edits (MUEs). The National Correct Coding Initiative (NCCI) contractor develops and maintains MUEs. This set of edits is based on anatomical considerations and addresses approximately 2,800 codes.
What Is an MUE?
An MUE is defined as an edit that tests claim lines for the same beneficiary, HCPCS code, date of service and billing provider against a required number of units of service. These MUEs will auto-deny claim line items containing units of service billed in excess of the MUE criteria.
How to Obtain Practitioner/Durable Medical Equipment (DME) Supplier Table
The table listing codes and values (number of units that may be billed) can be found at:
http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage
The table listing codes and values (number of units that may be billed) can be found at:
http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage
How Often Are the MUE Tables Updated?
The MUE values are updated quarterly.
Billing the Patient for Services Denied Due to the MUEs
Charges that are denied due to units in excess of the MUEs may not be billed to the beneficiary. The Advance Beneficiary Notice of Noncoverage (ABN) form cannot be used to seek payment from the beneficiary.
Charges that are denied due to units in excess of the MUEs may not be billed to the beneficiary. The Advance Beneficiary Notice of Noncoverage (ABN) form cannot be used to seek payment from the beneficiary.
Physician Concerns
Physicians who want to submit a request for reconsideration of an MUE value should address their concerns to the address listed below:
Physicians who want to submit a request for reconsideration of an MUE value should address their concerns to the address listed below:
National Correct Coding Initiative Correct Coding Solutions, LLC P.O. Box 907 Carmel, IN 46082-0907
Fax: (317) 571-1745
Fax: (317) 571-1745
