What does MUE of 0 mean?
What does MUE of 0 mean?
If the MUE value is listed as 0 (zero), the HCPCS Level II/CPT® code is invalid, not covered, bundled, not separately payable, statutorily excluded, or not reasonable and necessary in accordance with Medicare regulations or guidance.
What does 1 mean in NCCI edits?
1 (Allowed) The modifiers associated with NCCI are allowed with this PTP code pair when appropriate. 9 (Not Applicable) This indicator means that an NCCI edit does not apply to this PTP code pair. The edit for this PTP code pair was deleted retroactive to the implementation date.
What does MUE threshold mean?
Medically Unlikely Edit
MUE 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 medical claims.
What does MUE denial mean?
An MUE-associated denial is a coding denial, not a medical necessity denial; therefore, the provider can- not use an Advance Beneficiary Notice to transfer liability for claim payment to the patient. MUE Adjudication Indicators.
Can you bill more than MUE?
Denied as Medically Unlikely (MUE) If your service was denied based on a Medically Unlikely Edit (MUE), that means that the number of services you billed is more than the number allowed in one day. Services denied because of an MUE are considered a coding error. You cannot bill your patient.
What does 0 mean on NCCI edits?
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.
What is MUE and Mai?
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 stand for in pharmacy?
Medication-use evaluation (MUE) is a performance improve- ment method that focuses on evaluating and improving medi- cation-use processes with the goal of optimal patient outcomes.
What is an MAI Medicare?
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 is an adjudication indicator?
What does Mue mean in coding?
MUE 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 medical claims.
What is Mue adjudication indicator?
A MUE Adjudication Indicator is either a 1 (line edit), 2. (absolute date of service edit), or 3 (date of service edit). The Practitioner Services. MUE table which is published quarterly now includes the rationale behind a MUE.
What does Mue 2 mean?
MAI of “2”. MUEs for HCPCS codes with a MAI of “2” are absolute date of service edit. These are “per day edits based on policy”. Based on statue, description of HCPCS/CPT code, or coding guidance. CMS gives no instances in which a higher value would be correct and payable.
What is a Mue denial?
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.
