Medically Unlikely Edits
CMS National Correct Coding Initiative Program (NCCI) Medicare and Medicaid Program
Medically Unlikely Edits (MUEs) are used by the Medicare Administrative Contractors (MACs), including Durable Medical Equipment (DME) MACs, to reduce the improper payment rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. Not all HCPCS/CPT codes have an MUE.
This webpage has links to Frequently Asked Questions and Answers (FAQs), public Medicare MUE files, and the Publication Announcement Letter, which explain most aspects of the MUE program.
Although CMS publishes most MUE values on its website, other MUE values are confidential and are for CMS and CMS contractors use only. Confidential MUE values are not releasable. The public/confidential status of MUEs may change over time.
Inquiries about the MUE program, including those related to NCCI (PTP, MUE and Add-On) edits, should be sent to NCCIPTPMUE@cms.hhs.gov. Inquiries about a specific claim should be addressed to the appropriate MAC.
Inquiries about the rationale for an MUE value should be addressed to the appropriate MAC or 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, the procedure described in the Frequently Asked Questions (FAQs) should be followed. See the web link below. Such requests should be addressed to:
National Correct Coding Initiative
P.O. Box 368
Pittsboro, IN 46167
Fax #: 317-571-1745