Question:

Do anatomic considerations enter into CMS’s decision on the number of MUEs?

Answer:

Yes, anatomic considerations may limit units of service. For example, in the 2018 NCCI Manual, the Centers for Medicare & Medicaid Services (CMS) give the following examples:

  • The MUE value for an appendectomy is “1” since there is only one appendix.
  • The MUE for a knee brace is “2” because there are two knees and Medicare policy does not cover back-up equipment.
  • The MUE value for a lumbar spine procedure reported per lumbar vertebra or per lumbar interspace cannot exceed “5” since there are only five lumbar vertebrae or interspaces.
  • The MUE value for a procedure reported per lung lobe cannot exceed “5” since there are only five lung lobes (three in right lung and two in left lung).

 

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