Frequently Asked Questions


How were Medically Unlikely Edits (MUEs) developed?

MUEs were developed based on Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) code descriptors, CPT coding instructions, anatomic considerations, established CMS policies, nature of service/procedure, nature of analyte, nature of equipment, and clinical judgment. All edits based on clinical judgment as well as many others were reviewed by workgroups of contractor medical directors.

Prior to implementation of MUEs, the proposed edits were released for a review and comment period to the AMA, national medical/surgical societies, and other national healthcare organizations, including non-physician professional societies, hospital organizations, laboratory organizations, and durable medical equipment organizations.

In 2008 all MUE values were validated with 100% of submitted claims data for a six month period in 2006.

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