Medicare National Correct Coding Initiative Medically Unlikely Edits: Myth and Mystery
In the May 2025 issue of Advances in Skin & Wound Care, Kathleen D. Schaum, MS, addresses prevalent misconceptions surrounding the Medicare National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUEs). MUEs, introduced in 2007, are designed to prevent inappropriate Medicare payments by setting maximum units of service (UOS) that a provider can report for a single beneficiary on a single day.
Schaum emphasizes that MUEs are coding edits, not determinations of medical necessity. Therefore, denials based on MUEs are not subject to appeal through medical necessity channels. She also clarifies that providers should not circumvent MUEs by splitting services across multiple dates to avoid edit triggers, as this practice is discouraged and may lead to compliance issues.
The article highlights the existence of three separate MUE tables published by CMS: Practitioner Services MUE, DME Supplier Services MUE, and Facility Outpatient Hospital Services MUE. However, not all codes have associated MUEs, and the absence of an MUE does not imply unlimited billing for a service.
Read the full article on the Advances in Skin & Wound Care website.
Keywords:
Medically Unlikely Edits,
National Correct Coding Initiative,
Medicare compliance,
Coding edits,
CMS guidelines,
Wound care billing
Note: The above synopsis is based on the article’s content and available information. For a comprehensive understanding, please refer to the full article.