AHA Coding Clinic® for HCPCS - 2009 Issue 2; FOR your INFORMATION

Inappropriate use of an advanced beneficiary notice (ABN) with medically unlikely edits (MUE) denials

On December 8, 2006, the Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 5402, stating “Finally, excess charges due to units of service greater than the MUE may not be billed to the beneficiary (this is a “provider liability”) (sic), and this provision can neither be waived nor subject to an Advanced Beneficiary Notice (ABN). This information has not changed. An MUE denial is an initial determination based on a coding denial, not a medical necessity denial. By statue an ABN may be applied only if the initial determination on a claim results...

To read the full article, sign in and subscribe to the AHA Coding Clinic® for HCPCS.

The AHA Coding Clinic for HCPCS includes:

  • The official publication for Level I HCPCS (CPT-4 codes) for hospital providers
  • Also specific Level II HCPCS codes for hospitals, physicians and other health professionals
  • Current newsletters added each quarter
  • Full Archives back to 2001
  • Fully searchable through Find-A-Code's Comprehensive Search
  • Codes mentioned in articles are linked to Code Information pages
  • Code Information page link back to related articles
  • View all the articles associated with any code, right from the code page!
Access to this feature is available in the following products:
  • AHA's Coding Clinic® - HCPCS +Archives

free demo
request yours today
for any budget
sign IN
welcome back!