What are Medically Unlikely Edits (MUE)?
CMS developed Medically Unlikely Edits (MUEs) to reduce the paid claims error rate for Part B claims. An MUE for a Healthcare Common Procedural Coding System (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. All HCPCS/CPT codes do not have an MUE. MUE was implemented January 1, 2007 and is utilized to adjudicate claims at Carriers, Fiscal Intermediaries, and Durable Medical Equipment (DME) Medicare Administrative Contractors (MACs). Although CMS publishes most MUE values (the maximum number of reportable units) on its website, other MUE values are confidential and are for CMS and CMS Contractors’ use only. If you have concerns about the MUE program other than MUE values for specific codes, contact Valeria Allen (valeria.allen@cms.hhs.gov). Inquiries about a specific claim should be addressed to the claims processing contractor.
Related Questions
- I understand the discount applies to uninsured patients for medically necessary health care services. What exactly does that mean?
- How do I report medically reasonable and necessary units of service in excess of a Medically Unlikely Edit (MUE) value?
- How can providers find out about updates regarding the Medically Unlikely Edit (MUE) values?
