Frequently Asked Questions

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How were Medically Unlikely Edits (MUEs) developed?

Medically Unlikely Edits (MUEs) were developed based on the 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, prescribing information, and clinical data. All MUEs are evaluated with 100% claims data from a six month period.

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


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