Medicare NCCI Medically Unlikely Edits (MUEs)
Description
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 is the maximum units of service (UOS) reported for a HCPCS/CPT code on the vast majority of appropriately reported claims by the same provider/supplier for the same beneficiary on the same 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.
Medicare NCCI Medically Unlikely Edits | CMS
The Frequently Asked Questions and Answers (FAQs) and the NCCI Policy Manual for Medicare Services explain most aspects of the MUE program.
www.cms.gov
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Digest CMS MUE files. Store historical context for historical assessment.
MUE determine drug administration limits for Medicare Part B plans.
These can be used to quickly review and assess drug admins for payments.
Related Downloads
- DME Supplier Services MUE Table (ZIP) - Effective January 1, 2024; Posted Dec. 5, 2023
- Outpatient Hospital Services MUE Table (ZIP) - Effective January 1, 2024; Posted Dec. 5, 2023
- Practitioner Services MUE Table (ZIP) - Effective January 1, 2024; Posted Dec. 5, 2023
- Earlier MUE tables are available in the Medicare MUE Archive.