MUE Changes for Medicare – Third Quarter

Each quarter CMS makes updates to Medically Unlikely Edits (MUE’s) for all CPT codes.    The July 1, 2018, MUE list did not just include updates to allowable units for a few Pathology and Laboratory HCPCS (80000-89999), but also the MUE Adjudication Indicator (MAI) for some codes.  To review these changes, please review our White Paper by clicking here.

Particularly noteworthy is the change to the MUE for IHC stains (88341 and 88344) and the MAI associated with each. 

APS maintains tables in its proprietary billing system specific to CMS’ MUE’s and modifies claims prior to submission in order to allow for clean claim submission and payment.  Quarterly updates are in place to accommodate these changes. If you have questions about these changes, please contact your Practice Manager.