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CodeMap® Compliance Briefing: January 15, 2015


Editor's Welcome:  CMS has recently expanded Medically Unlikely Edits (MUEs) to include not only line item edits but also date of service edits. Line item MUEs are merely the maximum number of times a particular HCPCS code will be paid when listed on a single claim line. However, as we discuss below, some HCPCS codes are now subject to date of service edits, which limit the total number of times the code will be paid on a single day. Implementation of these new date of service edits has resulted in more complicated MUE tables, and as usual more complex rules regarding how MUEs are applied by Medicare contractors. As always, please let us know if you have any questions, comments, or suggestions via email.

Sincerely,

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