What is Mue adjudication indicator?

MUE Adjudication Indicator (MAI): Describes the type of. MAI 1: Applied at line level (claim line) – Appropriate use of modifiers to report the same code on separate lines of a claim will enable the reporting of medically necessary units of service in excess of MUE.

What is meant by MUE adjudication indicator?

What does an MUE Adjudication Indicator (MAI) mean? The MUE files on the CMS NCCI website display an MAI for each HCPCS/CPT code. An MAI of “1” indicates that the edit is a claim line edit. An MAI of “2” or “3” indicates that the edit is a date of service MUE.

How do I read MUE edits?

Quote from video on Youtube:Code an mai of one indicates the edit is a claim line level mue. When a code has an mai of 1 appropriate modifiers may be used to report the same code on a separate line or lines of the claim.

What does MUE stand for in coding?

CMS National Correct Coding Initiative Program (NCCI) Medicare and Medicaid Program. Medically Unlikely Edits (MUEs) are used by the Medicare Administrative Contractors (MACs), including Durable Medical Equipment (DME) MACs, to reduce the improper payment rate for Part B claims.

What is the MUE value?

The MUE value is an absolute date of service limit that may not be overridden or bypassed with a modifier.

What is a MUE denial?

An MUE-associated denial is a coding denial, not a medical necessity denial; therefore, the provider can- not use an Advance Beneficiary Notice to transfer liability for claim payment to the patient. MUE Adjudication Indicators.

What does MUE of 0 mean?

If the MUE value is listed as 0 (zero), the HCPCS Level II/CPT® code is invalid, not covered, bundled, not separately payable, statutorily excluded, or not reasonable and necessary in accordance with Medicare regulations or guidance.

Can you appeal an MUE denial?

If a claim denies on an MUE edit (published or nonpublished) the provider is free to submit an appeal with medical documentation of the need for the number of services billed.