Wiki how to 160 units of J1010

[simransehgal1977@yahoo.com]

hi anyone ever get paid for 160 units of J1010. we only get paid for 120 units as MUE is 120. can anyone suggest the proper way of billing J1010 so that we are paid fully.

 

[sls314]

hi anyone ever get paid for 160 units of J1010. we only get paid for 120 units as MUE is 120. can anyone suggest the proper way of billing J1010 so that we are paid fully.

Effective July 1, 2025, the MUE will be 160.

The MUE tables for 7/1/2025 are now available for viewing here: https://www.cms.gov/medicare/coding...-edits/medicare-ncci-medically-unlikely-edits

 

[jkyles]

hi anyone ever get paid for 160 units of J1010. we only get paid for 120 units as MUE is 120. can anyone suggest the proper way of billing J1010 so that we are paid fully.

Hi there, the MUE adjudication indicator for that code is 3, which means that you can appeal denials for services performed before July 1. From the NCCI manual https://www.cms.gov/files/document/01-chapter1-ncci-medicare-policy-manual-2025finalcleanpdf.pdf

MUEs for HCPCS codes with an MAI of “3” are “per day edits based on clinical benchmarks.”
MUEs assigned an MAI of “3” are based on criteria (e.g., nature of service, prescribing
information) combined with data such that it would be possible but medically highly unlikely
that higher values would represent correctly reported medically necessary services. If contractors
have evidence (e.g., medical review) that UOS in excess of the MUE value were actually
provided, were correctly coded and were medically necessary, the contractor may bypass the
MUE for a HCPCS code with an MAI of “3” during claim processing, reopening, or
redetermination, or in response to effectuation instructions from a reconsideration or higher-level
appeal.

For MUE appeals the provider should include a separate letter that explains in detail the medical reason for the excess units.