AHA Coding Clinic® for HCPCS - 2013 Issue 1

Modification of the Medicare Medically Unlikely Edit program

The Medically Unlikely Edit (MUE) program was implemented by the Centers for Medicare & Medicaid on January 1, 2007, to reduce the Medicare Part B paid claims error rate. An MUE represents the unit of service the same provider would ordinarily perform to the same patient on the same date of service. The MUE value is the maximum number of units of service (UOS) allowable under most circumstances that most providers would report for a single HCPCS/CPT code for services reported for the same patient on the same date of service. Although CMS defined MUEs based on UOS for...

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