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Reminder: Medically Unlikely Edits applied to professional and facility claims

September 6, 2017

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As previously communicated, there was a change to the processing of claim service units for professional claims that went into effect November 1, 2013. As a result, Medically Unlikely Edits (MUE) are applied to both professional and facility claims.

An MUE is assigned to certain HCPCS/CPT? codes identifying the maximum units of service a provider performs on a patient on a given date of service.

Note: Claim lines with billed units that exceed the Centers for Medicare & Medicaid Services (CMS)-published MUE values will be rejected on a pre- and/or post-payment basis.

CMS updates the MUE values on a quarterly basis coincident with each quarterly version of MUE. For a complete listing of CMS-published MUE values, visit the Medically Unlikely Edits section of the CMS website and select the applicable MUE Table under the Related Links header at the bottom of the page.

CPT copyright 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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