Medically Unlikely Edits (MUE)

The Centers for Medicare and Medicaid (CMS) developed Medically Unlikely Edits (MUEs) in 2007 to reduce the paid claims error rate for Part B claims. A MUE for a HCPCS/CPT code is the maximum number of units of service a provider/supplier should bill, under most circumstances, for one beneficiary on one date of service. Items billed above the number of units are considered medically unlikely and are automatically denied. All HCPCS/CPT codes do not have a MUE.

CMS publishes most MUE values on its website, and other MUE values are confidential and are for CMS and CMS Contractors' use only.

To view a list of published MUE values, please visit the CMS website. 

MUE claim denials may be appealed with documentation to support the number of units billed. If you would like to appeal a MUE denial, you may fax your Redetermination requests to (803) 462-2118.

You can mail your request to:

Palmetto GBA/Railroad Medicare Appeals
P.O. Box 10066
Augusta, GA 30999

You may also submit your appeal online through the eServices Portal.

Please do not mail and fax the same request. Multiple submissions for the same request slows processing time.

For more information on MUEs, please see CMS' Internet-Only Manual (IOM 100-04, Chapter 23 Section 20.9). These policies can be found on the CMS website at www.cms.gov. Or, you may call our Provider Contact Center at 888-355-9165. Representatives are available from 8:30 a.m. to 4:30 p.m. in all time zones with the exception of PT, which receives service from 8 a.m. to 4 p.m. PT.