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Medically Unlikely Edits (MUE)
April 2010
Transmittal 652, Change Request 6712, dated March 17, 2010 addresses Medically Unlikely Edits
(MUE). Read
the Transmittal in its entirety.
As you may be aware, MUEs were designed by CMS to reduce the paid claim error rate for Medicare claims. An MUE is a unit of service edit for a HCPCS/CPT code, for services that a single provider rendered to a single beneficiary on the same date of service.
CMS adjudicates MUEs against each line of a claim rather than the entire claim.
Since each line of a claim is adjudicated separately against a MUE of the code on a particular line, the use of modifiers (-76, -77, -91, -59) will enable a provider to report medically necessary units of service in excess of a MUE [emphasis added].
The effective date of this Transmittal is April 1, 2010; implementation date is April 5, 2010.
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