General Question for the Week of September 23, 2019

Question:

What are Medically Unlikely Edits?

Answer:

The Centers for Medicare & Medicaid Services established units-of-service edits referred to as medically unlikely edits (MUEs) to lower the Medicare fee-for-service paid claims error rate. An MUE for an HCPCS/CPT code is the maximum number of units of service allowed by the same provider for the same beneficiary on the same date of service. Units of service in excess of an MUE are denied. Note that MUEs do not exist for all HCPCS/CPT codes.

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