NCCI and MUE Updates

NCCI and MUE Updates

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.

NCCI and MUE Updates:

Quarterly PTP and MUE Version Update Changes