I received a denial with ANSI Reason Code 151 and Remark Code N362. What causes this denial?
This denial indicates that the number of items provided exceed the acceptable maximum. This denial is related to Medically Unlikely Edits (MUEs). The CMS developed Medically Unlikely Edits (MUEs) to reduce the paid claims error 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. MUEs are confidential and are for CMS and CMS Contractors’ use only; therefore, MUE values for specific HCPCS codes cannot be released since CMS does not publish MUEs. Information about MUEs is found at: http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp When this denial is received, it is necessary to submit a redetermination with medical documentation supporting the necessity of the items. To request a redetermination, please utilize the DME MAC Jurisdiction C Redetermination Request Form found on the DME MAC Forms Page.
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