51MUE Adjustment Process for Possible Overpayment

In 2011, Medicare incorrectly denied some HCPCs as Medically Unlikely. An effort has been underway to identify the claims with inappropriate 51MUE/52MUE denials and the Medicare Administrative Contractors (MACs) are preparing to create adjustments that will adjust the claims and correct the payments made to the submitting facilities. While testing the correction, one of the MACs identified some situations where the newly adjusted claims will create an overpayment. The overpayment is due to the way that certain HCPCs are coded on the Medically Unlikely Edits file that the System Maintainer is dependent upon to systemically identify the claims for adjustment. At this time, two HCPCs have been identified, but research is ongoing to determine the full impact. The identified HCPCs are 90804 and 94760. Because the first priority of CMS is to correct any underpayments that the providers have been subject to, it was decided that the MACs should proceed with the adjustment process. This means that you may potentially receive an overpayment on one or more of your claims that are adjusted. At this time it is not necessary for you to take any action on the overpayments. CMS is working with the System Maintainer on a solution and fully expects to recoup the overpayments systemically in the near future.

Source: https://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2013-02-14-enews.pdf