Medicare NCCI Medically Unlikely Edits


  • Please use the 2023 Q3 Edit Files until CMS posts the 2023 Q4 Edit Files

Medicare NCCI Medically Unlikely Edits (MUEs)

National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUEs) are used by the Medicare Administrative Contractors (MACs), to reduce improper payments for Part B claims. An MUE for a Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (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.  

Although CMS publishes most MUE values on its website, other MUE values are confidential. Confidential MUE values are not releasable. The confidential status of MUEs is subject to change.  

Quarterly Version Update Changes

CMS posts changes to each of its NCCI MUE published edit files on a quarterly basis. This includes additions, deletions, and revisions to published MUEs for Practitioner Services, Outpatient Hospital Services, and DME Supplier Services.

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Page Last Modified:
06/01/2023 01:52 PM