The Medically Unlikely Edit (MUE) program was established in January 2007 by the Centers for Medicare & Medicaid Services (CMS) in an effort to reduce payment errors on Medicare professional service (physician) claims. An MUE has been assigned on approximately 9,700 Current Procedural Terminology (CPT®) and Healthcare Common Procedure Coding System level 2 codes. Each edit represents the maximum number of units of service allowed for 1 provider for the same patient on the same date of service and is assigned to codes based on anatomic consideration, CPT code descriptor and coding guidelines, and applicable Medicare payment policy. For example, code 69210 (removal impacted cerumen, 1 or both ears) is assigned 1 unit based on the CPT code descriptor.

Many Medicaid programs and commercial payers adopt Medicare payment policies and may use the MUEs as part of their payment processes. You may want to become familiar with these edits. The...

You do not currently have access to this content.