Mar 7, 2025 · CMS posts changes to each of its NCCI MUE published edit files on a quarterly basis. This includes additions, deletions, and revisions to published MUEs for Practitioner Services, Outpatient Hospital Services, and DME Supplier Services.

A Medically Unlikely Edit (MUE) value assigned to a CPT/HCPCS code indicates the maximum units of service (UOS) for a single beneficiary on a single date of service (on most appropriately reported claims). NOTE: Not all CPT/HCPCS codes have an …

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. MUE values are not utilization guidelines.

An MUE for a HCPCS/CPT code is the maximum UOS you would report under most circumstances for a single patient on a single date of service. CMS develops MUEs based on: HCPCS/CPT code descriptors; CPT coding instructions; Anatomic considerations; Established CMS policies; Nature of service or procedure; Nature of analyte; Nature of equipment ...

Nov 21, 2023 · An MUE for a HCPCS/CPT code is the maximum units of service a provider would order under most circumstances for a single beneficiary on a single date of service. Not all HCPCS codes have an MUE. The Medically Unlikely Edit (MUE) Lookup Tool on this page, provides guidance for published MUEs for DME HCPCS …

Jan 12, 2022 · Fact 1: MUE Edits Limit Frequency Any practice filing a claim with Medicare should know what MUEs are and how they work, because these coding edits limit the frequency a CPT ® code can be used. Understanding MUEs allows you to better pinpoint when a claim is denied due to these edits versus those claims that should have been paid.

Apr 25, 2023 · 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. All HCPCS/CPT codes do not have an MUE.

• An MUE is defined as an edit that tests claim lines for the same beneficiary, Health Care Common Procedure Code System (HCPCS) code, date of service, and billing provider against a criteria number of units of service.

MUE Adjudication Indicator “2” This is an absolute date of service edit. UOS in excess of the MUE value would be considered impossible because of a statute, regulation or sub regulatory guidance. This includes correct coding policy that is binding for both providers and MACs. Note: When billing for bilateral services and the MAI

May 15, 2024 · The MUE files on the NCCI website display "MUE Adjudication Indicators" (MAIs) for each HCPCS/CPT code. An MAI of "1" indicates the edit is a claim line level MUE. When a HCPCS/CPT code has an MUE MAI of "1" or is a claim line edit, appropriate CPT modifiers may be used to report the same HCPCS/CPT code on a separate line or lines of a claim.