Medically Unlikely Edit

A Medically Unlikely Edit (MUE) is a US Medicare unit of service claim edit applied to Medical claims against a procedure code for medical services rendered by one provider/supplier to one patient on one day. Claim edits compare different values on medical claim to a set of defined criteria to check for irregularities, often in an automated claims processing system. 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.[1] MUE is part of the National Correct Coding Initiative (NCCI) to address coding methodologies. The NCCI policies are based on coding conventions by nationally recognized organizations and are updated annually or quarterly. [2]

  1. ^ CMS (September 25, 2009). "What is a Medically Unlikely Edit (MUE)?" (web). Q&A. Centers for Medicare and Medicaid Services. Retrieved January 21, 2010.
  2. ^ CMS (October 1, 2009). "National Correct Coding Initiatives Edits; Overview" (web). CMS Rule. Centers for Medicare and Medicaid Services. Retrieved January 21, 2010.