3. MUE edit limits with an MUE Adjudication Indicator of “3” (
Date of Service Edit
: Clinical): a. It would be possible but medically highly unlikely that more units than the MUE value would ever be performed on the same date of service for the same patient.
What does MUE adjudication indicator 3 date of service edit clinical mean?
MUEs for HCPCS codes with a MAI of “3” are “
per day edits based on clinical benchmarks
.” MAI 3 indicates it is unlikely additional units of service would appear on a correctly coded claim but could, under unusual circumstances, be payable.
What is meant by MUE adjudication indicator?
MUE Adjudication Indicator (MAI): Describes the type of. MAI 1: Applied at line level (claim line) – Appropriate use of modifiers to report the same code on separate lines
of a claim will enable the reporting of medically necessary units of service in excess of MUE
.
What is the adjudication indicator?
The MUE Adjudication Indicator (MAI)
indicates the type of MUE and its basis
. The MAI assigned to HCPCS/CPT codes will determine how your claim will process and/or deny.
What does MUE mean in medical billing?
Medically Unlikely Edits
(MUEs) are used by the Medicare Administrative Contractors (MACs), including Durable Medical Equipment (DME) MACs, to reduce the improper payment rate for Part B claims.
What does MUE of 0 mean?
A Publication Indicator of “0” indicates that the MUE value
for that code is
.
confidential
, is not in the CMS official publication of the MUE values, and should not be shared with. providers/suppliers or other parties outside the CMS contractor's organization.
How do I check my MUE edits?
CMS publishes most, but not all, of the MUE edit values in a table on the
CMS website
. You can access the CMS Medically Unlikely Edits page from the link below. Once on that page, scroll the page down to Related Links and choose Practitioner Services MUE Table.
What type of edit is a MUE?
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.
What is a claim line edit?
An MUE is a
unit of service edit for a Healthcare Common Procedure Coding System
(HCPCS) / Current Procedural Terminology (CPT) code for services rendered by a single provider/supplier to a single beneficiary on the same date of service.
What indicates the frequency of care on a UB 04 claim form?
A four-digit code; the first digit is a leading zero, the second digit identifies the type of facility where services were rendered, the third digit classifies the type of care being billed, and the
fourth digit
, a “frequency” code, indicates the sequence of the bill within a given episode of care.
What is a distinct procedural service?
Modifier 59 Distinct Procedural Service indicates that
a procedure is separate and distinct from another procedure on the same date of service
. Typically, this modifier is applied to a procedure code that is not ordinarily paid separately from the first procedure but should be paid per the specifics of the situation.
What is a date of service edit?
The date of service edits
apply to all services provided on a given date
. Eventually, CMS plans to convert all line edits to date of service edits (which does not allow billing on two different lines).
What is modifier 76 medical billing?
Modifier 76
Used to indicate
a procedure or service was repeated by the same physician or other qualified health care professional subsequent to
the original procedure or service.
What are Medicare NCCI edits?
The CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. … The purpose of the NCCI PTP edits is
to prevent improper payment when incorrect code combinations are reported
.
What is the meaning of MUE?
| Acronym Definition | MUE Medically Unlikely Edit | MUE Mission Unique Electronics | MUE Mission Unique Equipment | MUE Multi-Use Easement |
|---|
What does a 0 in an NCCI edit mean?
A modifier indicator of “0” indicates
that an edit can never be bypassed even if a modifier is used
. In other words, the Column 2 code of the edit will be denied. A modifier indicator of “1” indicates that an edit may be bypassed with an appropriate modifier appended to the Column 1 and/or Column 2 code.
