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Medically Unlikely Edits (MUEs) Reminder

Published 01/12/2018

Medically Unlikely Edits (MUEs) may be maximized at either one per day or one per line. A MUE denial is a coding denial, not a medical necessity denial. A provider shall not issue an Advance Beneficiary Notice of Non-coverage (ABN) in connection with services denied due to a MUE and cannot bill the beneficiary for units of service denied. The denied units of service shall be a provider/supplier liability.

Providers should not interpret MUE values as utilization guidelines. MUE values do not represent units of service providers may report and avoid further medical review. Providers should continue to report only services that are medically reasonable and necessary. For further information on MUEs and the MUE process, visit the Frequently Asked Questions (FAQs) on the CMS website and type 'MUE' in the 'Search' box in the upper left corner.

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