"Medically Unlikely Edits" (MUEs)

The Centers for Medicare and Medicaid Services (CMS), working through a National Correct Coding Initiative (NCCI) contractor, has proposed maximum allowable number of units of service per patient, per day referred to as Medically Unlikely Edits (MUEs).  Unlike some NCCI edits, MUEs cannot be bypassed with NCCI-associated modifiers. 

When the MUEs were first announced in late 2005, ACLA was one of the first groups to meet with high level CMS officials to raise concerns that the proposed unit of service edits for pathology and clinical laboratory medicine were inconsistent with accepted medical practice, needed clearer explanation of the selection criteria, should include the opportunity to appeal the proposed edit, and, if implemented, would have negative healthcare consequences for Medicare recipients.  After meeting with CMS, ACLA was informed that CMS would release the MUEs in phases and allow for review and comment.  ACLA is an active participant in the review and comment process.