Medicare NCCI Medically Unlikely Edits (MUEs) - CMS
Dec 1, 2025 · National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUEs) are used by the Medicare Administrative Contractors (MACs), to reduce improper payments for Part B …
Medicare NCCI FAQ Library | CMS
May 28, 2025 · There are both date of service and claim line MUEs. CMS publishes which codes have a date of service and which codes have claim line MUEs. For date of service MUEs, the …
Aug 15, 2014 · Because MUEs are based on current coding instructions and practices, MUEs are prospective edits applicable to the time period for which the edit is effective. A change in an …
In order to lower the Medicare fee-for-service paid claims error rate, the Centers for Medicare & Medicaid Services (CMS) established units of service edits referred to below as MUEs.
During the test period, CMS will assess the impact of MUEs on Medicare beneficiaries, providers, and contractors. Based upon the results of the test, CMS will modify MUE criteria as appropriate.
Medicare NCCI MUE Archive | CMS
Apr 1, 2022 · Below is an archive of previous versions of the NCCI Medicare MUE files. These aren’t current NCCI edits files. We’ve posted these versions for historical reference only.Get …
Because MUEs are a mechanism to identify obvious billing mistakes and are not designed to set payment policy or determine medical necessity, CMS does not need to use the rule making …
Medicaid NCCI FAQ Library | CMS
Are all Medicaid NCCI PTP edits and MUEs published and available to states and providers on the CMS website? All currently active and previously active Medicaid PTP edits are published …
Feb 28, 2025 · The NCCI Policy Manual for Medicaid Services provides technical coding information that state Medicaid agencies, fiscal agents, and providers may use to understand …
Medicaid NCCI Edit Files | CMS
Dec 1, 2025 · The presence of an HCPCS/CPT code in a Procedure-to-Procedure (PTP) edit - or a Medically Unlikely Edits (MUEs) value for an HCPCS/CPT code - doesn’t necessarily …