AHA Coding Clinic® for HCPCS - 2007 Issue 3; FOR your INFORMATION

Medically unlikely edits

CMS has established unit of service edits, titled Medically Unlikely Edits (MUE), to lower Medicare’s fee for service paid claims error rate. MUEs, which are housed by the National Correct Coding Initiative (NCCI) contractor, are defined as edits that check specific claim lines for the same beneficiary, HCPCS code, date of service, and billing provider against a predefined number of units of service. If a unit of service is reported in excess of the MUE criteria for that HCPCS code, Medicare contractors, specifically Carriers and MACs, will deny the entire claim line when the units of service are...

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