MUE - Medically Unlikely Edits

Note Due to AMA copyright on CPT, you must be a registered user: either on free trial, Advanced or Standard subscription - to use this part of the ICD10Doc application

Watch a brief YouTube movie and see how easy it is to edit a code with MUE using ICD10Doc.

1. Find a CPT code that interests you, with the search or reverse search functions on the Home page. The result will show in its own box as CPT / HCPCS. Click on the link that you'd like to continue with.

2. Scroll down on the next screen to MUE box.



These are the maximum Units of Service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service for a CPT code.

Background

An MUE for a HCPCS/CPT code is the maximum Units of Service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service.

Not all HCPCS/CPT codes have an MUE. MUEs are developed based on HCPCS/CPT code descriptors, CPT coding instructions, anatomic considerations, established CMS policies, nature of service/procedure, nature of analyte, nature of equipment, prescribing information, and clinical judgment.

Most MUEs are visible to providers on the CMS website. However, some MUEs are considered confidential by CMS and are not released.

Claims processing contractors may have UOS edits that are more restrictive than MUEs. In such cases, the more restrictive claims processing contractor edit would be applied to the claim. Similarly, if the MUE is more restrictive than a claims processing contractor edit, the more restrictive MUE would apply.

MUE values are not utilization guidelines and do NOT represent UOS that may be reported without concern about medical review. Providers should continue to only report services that are medically reasonable and necessary. Providers may be subject to medical review of their claims even if they report UOS less than or equal to the MUE value for a code.

For more information on MUE visit CMS web site
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