Medically Unlikely Edits Durable Medical Equipment Supplier Services

$179 / year

This dataset showcases the Medically Unlikely Edits (MUEs) for Durable Medical Equipment Supplier Services as defined for many Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes, the maximum allowable number of units of service by the same provider, for the same beneficiary, the same date of service, on the same claim line. Reported units of service greater than the MUE value are unlikely to be correct.

Complexity

The Centers for Medicare and Medicaid Services (CMS) developed the Medically Unlikely Edit (MUE) program to reduce the paid claims error rate for Part B claims. The first edits were implemented on January 1, 2007. Subsequently, there have been quarterly updates increasing the number of edits. The edits were developed based on anatomic considerations, HCPCS/CPT code descriptors, CPT instructions, CMS policies, nature of service/procedure, nature of the analyte, nature of the equipment, and clinical judgment. Prior to implementation, all edits were reviewed by national healthcare organizations, and their alternative recommendations were taken into consideration.

MUEs differ from the National Correct Coding Initiative (NCCI) edits. The NCCI edits identify which procedures and services are bundled and should not be billed together. MUEs limit the number of times a service or procedure can be reported by a physician on the same date of service to an individual patient. MUEs apply not only to services and procedures but also to durable medical equipment and drugs. CMS developed the MUE program to reduce the error rate for Part B coding and to control improper payments. The edits are based on anatomic considerations, HCPCS/CPT code descriptors, CPT coding instruction, CMS policies, nature of service or procedure, and nature of analyte or equipment. Generally speaking, the MUEs are considered a tool for limiting fraud and abuse activity, which has become a focus of the agency over the past few years.

A Medically Unlikely Edit (MUE) is a US Medicare unit of service claim edit applied to Medical claims against a procedure code for medical services rendered by one provider/supplier to one patient on one day. Claim edits compare different values on the medical claim to a set of defined criteria to check for irregularities, often in an automated claims processing system. MUEs are designed to limit fraud and/or coding errors. They represent an upper limit that unquestionably requires further documentation to support. The ideal MUE is the maximum unit of service for a code on the majority of the medical claims. MUE is part of the National Correct Coding Initiative (NCCI) to address coding methodologies. The MUE Durable Medical Equipment Supplier Services for the third quarter of 2017 are released on the CMS website on June 02, 2017 and will be effective from July 1, 2017 to September 30, 2017.

Date Created

2015-12

Last Modified

2018-01-01

Version

2018-01-01

Update Frequency

Quarterly

Temporal Coverage

2017-07 to 2018-01

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

CPT codes, descriptions and other data only are copyright 1995 - 2016 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).

Source Citation

NA

Keywords

2017 MUE for 3rd Quarter, MUE DME Supplier Services, Durable Medical Equipment Supplier Services, Quarterly MUE Version updates, Medical Billing, Billing Cost, NCCI Edits, CCI Edits, MUE DME Supplier Services, Quarterly MUE Version Updates

Other Titles

2017 MUE DME Supplier services, DME Supplier Services MUE Values, Durable Medical Equipment Supplier Services MUE Values, MUE Adjudication Indicator, 2017 MUE DME Supplier Services, DME Supplier Services MUE Values, Durable Medical Equipment Supplier Services MUE Values, MUE Adjudication Indicator, 2017 MUE for 3rd Quarter, Durable Medical Equipment Supplier Services

NameDescriptionTypeConstraints
HCPCS_and_CPT_Code5 digit code that contains the Physicians Current Procedural Terminologystring-
DME_Supplier_Services_MUE_ValuesRepresents the maximum units of service that a DME Supplier would report under most circumstances for a single beneficiary on a single date of service.integerlevel : Nominal
MUE_Adjudication_IndicatorDescribes the type of MUE.string-
MUE_RationaleDescribes the underlying basis for each MUE.string-
HCPCS and CPT CodeDME Supplier Services MUE ValuesMUE Adjudication IndicatorMUE Rationale
A42063 Date of Service Edit: ClinicalCMS Policy
A42073 Date of Service Edit: ClinicalCMS Policy
A42083 Date of Service Edit: ClinicalCMS Policy
A42093 Date of Service Edit: ClinicalCMS Policy
A42103 Date of Service Edit: ClinicalCMS Policy
A42113 Date of Service Edit: ClinicalCMS Policy
A42133 Date of Service Edit: ClinicalCMS Policy
A42153 Date of Service Edit: ClinicalCMS Policy
A42214.03 Date of Service Edit: ClinicalClinical: Data
A42233 Date of Service Edit: ClinicalPublished Contractor Policy