CMS Announces on Sept 18, 2008 Medically Unlikely Edits Will be Published

CMS developed the Medically Unlikely Edit (MUE) program to reduce the paid claims error rate for Part B claims. The first edits were implemented January 1, 2007. Subsequently there have been quarterly updates increasing the number of edits.

CMS announces that beginning October 1, 2008, coincident with implementation of MUE version 2.3, the majority of existing MUEs will be made public and posted quarterly on the CMS website accessed through the MUE webpage.

The published MUE will consist of most of the codes with MUE values of 1-3. At some future time, these edits will also be available from the National Technical Information Service.

CMS will not publish all MUE values that are 4 or higher because of CMS concerns about fraud and abuse.

If a national healthcare organization, provider, or other party wants to submit a request for reconsideration of an MUE value, the procedure described in the MUE Frequently Asked Questions (FAQ) should be followed. See the web link below. Such requests should be addressed to:

National Correct Coding Initiative
Correct Coding Solutions, LLC
P.O. Box 907
Carmel, IN 46082-0907

Fax #: 317-571-1745