Medically Unlikely Edits (MUEs) are a cost saver for insurance companies, but for post-mastectomy service providers, they can be a bane to both clients, fitters, and billers.
What exactly are Medically Unlikely Edits (MUEs)?
Initially, the Centers for Medicare and Medicaid Services (CMS) developed Medically Unlikely Edits (MUEs) on January 1, 2007, to reduce the paid claims error rate for Part B claims.
MUEs apply to Carriers, Fiscal Intermediaries, and DME MAC.
An MUE for an HCPCS code is the maximum number of units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
But not all HCPCS codes have a value. CMS publishes most MUE values on its website; however, there are a few codes where limitations are confidential, for CMS and CMS Contractors’ use only.