Frequently Asked Questions

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FAQ

Is there an appeal process for units of service (UOS) denied based on Medically Unlikely Edits (MUEs)?

Units of service (UOS) denied due to a Medically Unlikely Edit (MUE), whether a claim line MUE or date of service MUE, may be appealed. Appeals should be submitted to local contractors not the MUE contractor, Correct Coding Solutions WP LLC. Contractors adjudicating appeals will determine whether (1) the appropriate Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) code is reported; (2) the appropriate number of UOS is reported; and (3) whether the UOS reported are medically reasonable and necessary. Contractors may pay UOS in excess of the MUE value if the contractor determines that they are medically reasonable and necessary.
(FAQ11354)

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