Medically Unlikely Edit for J1559

CMS plans to increase the current Medically Unlikely Edit (MUE) units allowed per day for HCPCS code J1559 (Injection, immune globulin (Hizentra), 100 mg), currently set at 1600 to 2400. This update is scheduled with the implementation of the January 2023 quarterly MUE file and will be retroactive to July 1, 2022.

Until the change is implemented, Medicare contractors will hold claims submitted with J1559 with units of service >1500 and =2400 for dates of service on or after July 1, 2022, through September 30, 2022, and hold claims submitted with units of service >1600 and =2400 for dates of service on or after October 1, 2022, through December 31, 2022.

Noridian will be adjusting claims that have already processed during this time that were denied. Adjustments will be processed within 60 business days following the MUE update in January 2023.

Prior to the implementation of the MUE quarterly update file for January 1, 2023, providers may choose to delay submission of claims until after the January 1, 2023 implementation of the July 1, 2022 retroactive date.

Note: Appeals will not be necessary for denials as the claims will be adjusted as listed above.

 

Last Updated Dec 06 , 2022