Tip: Be prepared for medically unlikely edits
APCs Insider, August 24, 2012
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Medically unlikely edits (MUEs) represent the maximum number of units of a given service that a patient should receive on a given date of service. CMS bases MUEs on several factors, including anatomy, code description, the agency’s own policies, and the overall nature of a service.
CMS has published some, but not all, of the MUEs online. CMS generally does not publish codes with an MUE value of 4 or higher.
Remember that not all CPT and HCPCS codes have MUE values. In fact, the majority of codes will not trigger an MUE edit.
It’s also important not to view MUE edits as utilization guidelines. In certain situations, the provider may legitimately decide the patient needs additional units of a specific service.
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