Top Provider Questions – Medically Unlikely Edits (MUEs)
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- Is an MUE denial considered a medically denied line? Do we need a corrected UB-04 for MUE for appeals? Or can this be changed so that we can correct and re-bill?
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A denial of services due to an MUE is a coding denial, not a medical necessity denial. However, since MUEs are auto-deny edits, denials may be appealed. A corrected UB-04 is not needed as long as the redetermination request is clear and concise.
Reference: CMS MLN Matters article MM8853
Reviewed 09/22/2021
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- How often is MUE information updated?
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MUEs are updated quarterly. Although CMS publishes most MUE values on its website, other MUE values are confidential and are for CMS and CMS Contractors' use only. Per CMS, these groups of MUE values cannot be released since CMS does not publish them. Review the CMS Facility Outpatient Services MUE Tables for published MUE values on the CMS Medically Unlikely Edits website.
Reviewed 09/22/2021
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- If we disagree with a CMS MUE value, what steps can we take? We have evidence from another source that supports our position.
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One step you can take is to send your question about the rationale for an MUE value can to a national healthcare organization whose members often perform the procedure. If a national healthcare organization, provider, or other party wants to submit a request for reconsideration of an MUE value, follow the procedure described in the MUE Frequently Asked Questions (FAQs). Such requests should be addressed to:
National Correct Coding Initiative
Correct Coding Solutions, LLC
P.O. Box 907
Carmel, IN 46082-0907
Fax #: 317-571-1745Reminder: as with all A/B Medicare Administrative Contractors (MACs), CGS must follow the CMS MUE values when editing claims. The CMS Medically Unlikely Edits website includes MUE methodology and links to the MUE FAQs and files.
Reviewed 09/22/2021
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- How can we find out an MUE amount if the code is not on the MUE list?
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Although CMS publishes most MUE values on its website, other MUE values are confidential and are for CMS and CMS Contractors' use only. The latter group of MUE values should not be released since CMS does not publish them.
Reviewed 09/22/2021
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