Check MUEs to Avoid Unit Errors on Your Claim

Distinguish practitioner, DME, and outpatient MUEs for Medicare and Medicaid.

Medically Unlikely Edits (MUEs) let you know the maximum units of service a payer expects to see for a code on a date of service. You can expect issues for your claim if units exceed the MUE.

Checking MUEs isn’t always straightforward, though. Medicare and Medicaid each create their own MUEs and update them quarterly. Beyond that, there are also separate MUEs for practitioners, durable medical equipment (DME), and for outpatient facilities. If your Codify package includes MUEs, here’s how to access them from the top navigation menu.

Step 1: Select Coding Tools/Medically Unlikely Edits. Then click MCR MUE for Medicare or MCD MUE for Medicaid.

Step 2: When the tool opens, enter the code, year, and quarter for your encounter. Click calculate to view the results. As the figure below shows, the Medicare tool also includes the MAI (MUE Adjudication Indicator) next to the MUE. Click the MAI for a definition explaining whether (and how) Medicare allows you to exceed the MUE. Bonus: Also look for MUEs on code details pages, listing (range) pages, the CMS-1500 scrubber, and in the Part B fees tool.

Bonus: Also look for MUEs on code details pages, listing (range) pages, the CMS-1500 scrubber, and in the Part B fees tool.

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Deborah Marsh

Deborah Marsh, JD, MA, CPC, CHONC, is a senior development editor at AAPC. She has explored the ins and outs of coding for multiple specialties, particularly radiology, cardiology, and oncology.

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