Medically Unlikely Edit (MUE)
A Medically Unlikely Edit (MUE) is the maximum number of units of service for a specific HCPCS code. The intent of MUEs is to allow the majority of appropriately coded claims to pass and catch those claims that have an unlikely amount of units.
A Medically Unlikely Edit (MUE) is the maximum number of units of service for a specific HCPCS code. The intent of MUEs is to allow the majority of appropriately coded claims to pass and catch those claims that have an unlikely amount of units.
Repair codes, billed in 15-minute increments, have MUEs attached. L4205, Repair of Orthotic Device has an MUE value of eight. L7520, Repair of Prosthetic Device, has an MUE value of 12.
If you received a claim denial due to exceeding MUE units, you may immediately begin the appeal process. If, in the case of repairs, you have detailed documentation outlining the type of repair and time involved, you have a strong appeal.
You may find out more about Medically Unlikely Edits here.