Medically Unlikely Edit (MUE) - Number of Days or Units of Service Exceeds Acceptable Maximum - JF Part B
Medically Unlikely Edit (MUE) - Number of Days or Units of Service Exceeds Acceptable Maximum
|Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
Common Reasons for Message
- Number of days or units billed exceeds acceptable Medically Unlikely Edit (MUE) maximum established by CMS
- View more information about MUEs
- Access the MUE lookup tool to see a procedure code’s assigned MUE Adjudication Indicator (MAI) where considerations may be accepted with applicable modifiers, never accepted, or accepted rarely.
- View the units of service and rationale for the MUE (i.e. clinical).
- Gain access to quarterly MUE version update changes.
- How to submit a reconsideration for a MUE edit to be reviewed (beyond a specific claim) is provided.
- Submit an Appeal request - Items or services with this message have appeal rights
- See Appeals webpage for instructions on how to submit a Reopening or Redetermination
Claim Submission Tips
- Although CMS publishes most MUE values on its website, other MUE values are confidential and are for CMS and Contractors' use only
- Report services that are medically reasonable and necessary