Q&A: What to do when an MUE should not apply to a claim

Article Overview

This article is a brief coding and reimbursement Q&A focused on medically unlikely edits in the context of HCPCS drug claims. It explains the general issue, the types of documentation and review considerations involved, and the kinds of escalation paths that may be relevant for billing, compliance, and appeals teams. The piece is aimed at hospital and physician practice staff who work with claim edits, drug billing, and supporting documentation.