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Disclosure of Medically Unlikely Edits

February 1, 2016

Disclosure of Medically Unlikely Edits

Many practicing allergists have been frustrated by not knowing how many tests or procedures is too many, and if they will be paid by Medicare if this unknown number is exceeded. The Advocacy Council recently learned, from a CMS medical officer involved in the review of Medically Unlikely Edits (MUEs), that CMS is still in the process of reviewing and making publically available the MUEs for all codes, but that this is taking longer than expected.  Last year we had been informed by CMS that the MUE for a number of allergy codes, in the range of 95004 – 95165, would probably be released sometime in 2015. While the year has ended and we still do not have the information, we are encouraged by the news from CMS that they continue to meet weekly to review codes and convert them from per-line to per-day edits (as recommended by the Government Accountability Office – GAO). We all would like more certainty in our billing, and we hope the release of the MUE numbers for some of our frequently used procedure codes will occur within the next six months.

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