AHA Coding Clinic® for HCPCS - 2009 Issue 4

Understanding Medically Unlikely Edits

Medically Unlikely Edits (MUEs) are edits that providers should become familiar with and understand their implications. Initially called “Medically Unbelievable Edits,” these edits were established in 2007 by CMS to reduce the paid claims error rate for Medicare Part B claims. An MUE for a HCPCS code is the maximum number of units of service that a provider may report under most circumstances for the same beneficiary, HCPCS code, date of service, and billing provider. MUEs were designed to reduce errors due to clerical entries and incorrect coding based on anatomic considerations, HCPCS code descriptors, CPT coding...

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