Question

The edit which flags cases that report an excessive number of units of service reported on a single encounter date is called________.

Answer 1

The edit which flags cases that report an excessive number of units of service reported on a single encounter date is called MUEs.

The Medicare Administrative Contractors (MACs), especially Durable Medical Equipment (DME) MACs, use Medically Unlikely Edits (MUEs) to lower the inappropriate payment rate for Part B claims.

The maximum units of services (MUE) for an HCPCS/CPT code are those that, in the majority of cases, a provider would report for a single beneficiary on a single date of service. A MUE is not present in all HCPCS/CPT codes.

This page includes links to the Publication Announcement Letter, the Frequently Asked Questions and Answers (FAQs), and the public Medicare MUE files, which cover the majority of the MUE program's details.

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