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March 27, 2018

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CMS Publishes MUE Edits

October 14, 2008:

On October 1, 2008, the Centers for Medicare and Medicaid Services published more than a quarter of the medically unlikely edits. In the past the agency has maintained the proprietary nature of the edits. Edits intended to detect and discourage any questionable payments will not be published, as the agency feels the efficacy of these edits would be compromised.

The list contains approximately 2,600 of the 9,700 current MUEs. MUEs are updated quarterly, and CMS plans to publish each update.

Effective January 1, 2007, in an effort to lower the Medicare fee-for-service paid claims error rate, CMS implemented edits that are referred to as the “medically unlikely edits.” An MUE for a HCPCS or CPT code is the maximum number of units of service allowable by the same provider for the same beneficiary on the same date of service. Units of service that exceed an MUE are denied.

Edits will be added in phases, with the initial MUEs focused on anatomic considerations. As an example, the MUE for a hysterectomy is 1, since women have only one uterus.

The edits will be published on the CMS website at http://www.cms.hhs.gov/NationalCorrectCodInitEd/08_MUE.asp#TopOfPage


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