Medically Unlikely Edits
What does it mean when your EOB shows a Remark Code 151?
Reason Code 151
This code on your EOB indicates the quantity of items delivered are not within the the frequency limits defined in the appropriate LCD. It is a Medically Unlikely Edit.
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 indicate 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 to you?
Be aware of the MUE for services you provide. You can download the full table of MUE edits here.
Noridian provides an MUE look up tool for you to use. You may access the tool 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 ›