Medically Unlikely Edits

A Medically Unlikely Edit (MUE) is a unit of service for a specific HCPCS code. CMS establishes the number of maximum units allowed to be billed by HCPCS code. The MUE indicates the quantity of the associated item which can be billed to a patient at one time.

If a HCPCS code has an established maximum MUE, and a provider bills more than this amount, the excess units will be denied on the claim.

What does this mean for you?

Be aware of the MUE for services you provide. You can download the full table of MUE edits here.

The majority of MUE are published and there are a few confidential units that are available only to CMS contractors.

If you have a denial based upon excessive MUEs, appeal directly to your MAC.

Remember, an MUE denial is based upon coding and quantity, not medical necessity.

Learn more about Medically Unlikely Edits at the CMS site.