How can I determine if an MUE value applies to the date of service or the line of service?

Answer
CMS assigns an MUE Adjudication Indicator (MAI) to each HCPCS code that has been assigned an MUE value. All published MUEs are published with their MAI and their MUE rationale.

  • An MAI of one means the MUE for the HCPCS code is adjudicated as a claim line edit. The edit applies to all units billed on a single claim line.
  • An MAI of two or three means the MUE for the HCPCS code is a date of service edit. Date of service edits apply to all units of service billed for the procedure code for the same date of service, Medicare Number and provider.

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