National Correct Coding Initiative (NCCI) Edits
Since 1996 the Medicare NCCI procedure to procedure edits have been assigned to either the Column One/Column Two Correct Coding edit file or the Mutually Exclusive edit file based on the criterion for each edit. The Mutually Exclusive edit file included edits where two procedures could not be performed at the same patient encounter because the two procedures were mutually exclusive based on anatomic, temporal, or gender considerations. All other edits were assigned to the Column One/Column Two Correct Coding edit file.
For more information on NCCI Edits, see the CMS page detailing the program and providing updates.
Medically Unlikely Edits (MUEs)
CMS developed Medically Unlikely Edits (MUEs) to reduce the paid claims error rate for Part B claims. An MUE for a HCPCS/CPT code is the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. All HCPCS/CPT codes do not have an MUE. MUE was implemented January 1, 2007 and is utilized to adjudicate claims at Carriers, Fiscal Intermediaries, and DME MACs.
For more information on MUEs, see the CMS page detailing the program and providing updates.
CMS Makes Changes to Medically Unlikely Edits (MUEs) Effective April 1, 2013 (2/18/2013):
The Centers for Medicare and Medicaid Services (CMS) recently announced modifications to the Medicare MUE program to reduce Part B paid claim error rates. CMS will be changing some MUE values to date of service (DOS) edits, rather than previous units of service (UOS) line edits. For codes undergoing this change, there are two categories: procedures that would "almost never" be reported with more the than one UOS, and codes where CMS expects that paid UOS in excess of the MUE would occur uncommonly. See the CMS letter here.
Page Last Updated on April 1, 2013
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