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20th Sep

MUE

What Does That Stand For?

 

We live in a world full of acronyms. LOL, BRB, COT, MDS, ADL, PUF, PEPPER, and the list goes on!

So, what does MUE stand for? Medically Unlikely Edits

What does this mean? CMS developed MUEs to decrease the paid claims error rate for Part B claims. This is the maximum units of service (HCPC/CPT code) that a provider can report under most circumstances per patient, per date of service. This was implemented January 1, 2007 and has been utilized to adjudicate claims. Not all HCPC/CPT codes have an MUE.

Why are these important? If these MUEs are not followed correctly, claims will deny. This is how it works. Since MUEs are edits, when the facility submits a claim, there are many edits in the CMS software to ‘scrub’ the claim, if you will, to see if the claim is “clean” for processing. If they get a “hit” on the edits, then the claim will go through to see if the claim matches the edits and if not, the claim item(s) will deny. This process happens when the claim is submitted for payment. The edits can identify when a KX and/or -59 modifiers are not applied to the claim, or diagnoses are not on the claim, or the revenue code is incorrect, etc.

How does this relate to therapy? Well, therapists provide therapy care and they bill for that care. Business Office Managers will need to bill per line item and attach the -59 modifiers to avoid denials.

This table below outlines some frequently used therapy CPT codes, the code description, how many units can be billed over dates of service. Let’s take a look:

CPT CodeCPT Code DescriptionNumber of UnitsNumber of days
92507Speech Treatment13 Date of Service
92610Dysphagia Evaluation12 Date of Service
92526Dysphagia Treatment12 Date of Service
97012Mechanical Traction13 Date of Service
97018Paraffin13 Date of Service
97022Whirlpool13 Date of Service
97024Diathermy13 Date of Service
97032Electrical Stimulation, constant attendance43 Date of Service
97035Ultrasound23 Date of Service
97110Therapeutic Exercise83 Date of Service
97112Neuromuscular Re-education63 Date of Service
97116Gait Training43 Date of Service
97124Massage43 Date of Service
97140Manual Therapy63 Date of Service
97150Group Therapy23 Date of Service
97161; 97162; 79163PT eval12 Date of Service
97164PT re-eval12 Date of Service
97165; 97166; 97167OT eval12 Date of Service
97168OT re-eval12 Date of Service
97530Therapeutic Activities63 Date of Service
97532Cognitive Skills Retraining83 Date of Service
97535Self-Care Retraining83 Date of Service
97542Wheelchair Management83 Date of Service
G0283Electrical Stimulation, non-wound13 Date of Service
97760Orthotics Management & Training63 Date of Service
97761Initial mobility & functional activity training with orthotic/prosthetic63 Date of Service
97762Check for orthotic/prosthetic use;43 Date of Service

For a full list of MUEs, click here for the link to CMS website.

Let’s look at an example. If therapy bills for more than 8 units of 97110 (therapeutic exercise) over 3 dates of service, the services that exceed 8 units will be denied if a -59 modifiers is not applied.

It’s important to understand how MUEs will affect your claim. If not, you will be SYH (Shaking Your Head)!

Gina Tomcsik

Director of Compliance

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