AHA Coding Clinic® for HCPCS - 2010 Issue 2; FOR your INFORMATION

Current Changes in the Medically Unlikely Edit (MUE) Program

Prior to April 1, 2010, when a provider reported units of service in excess of the MUE value for any code on a single line of a claim, the entire claim would be returned to the provider. Effective April 1, 2010, A/B Medicare Administrative Contractors (MACs) and Fiscal Intermediaries processing outpatient facility claims (TOB 13X, 14X, 85X) will deny individual claims lines. If the unit of service (UOS) on a claim line exceeds the MUE for the code on that claim line, the claim line is denied. Providers will have appeal rights for services denied due to an MUE...

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