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What does the MUE adjudication indicator mean?

What does the MUE adjudication indicator mean?

MUE Adjudication Indicator (MAI): Describes the type of. MAI 1: Applied at line level (claim line) – Appropriate use of modifiers to report the same code on separate lines of a claim will enable the reporting of medically necessary units of service in excess of MUE.

What is Unit Medicare MUE Mai 3?

MUEs for HCPCS codes with a MAI of “3” are “per day edits based on clinical benchmarks.” MAI 3 indicates it is unlikely additional units of service would appear on a correctly coded claim but could, under unusual circumstances, be payable.

What is the adjudication indicator?

The MUE Adjudication Indicator (MAI) indicates the type of MUE and its basis. The MAI assigned to HCPCS/CPT codes will determine how your claim will process and/or deny.

What does MAI of 2 mean?

absolute date of service edit
MUEs for HCPCS codes with a MAI of “2” are absolute date of service edit. These are “per. day edits based on policy”. HCPCS codes with an MAI of “2” have been rigorously. reviewed and vetted within CMS and obtain this MAI designation because UOS on the same.

What does MUE of 0 mean?

If the MUE value is listed as 0 (zero), the HCPCS Level II/CPT® code is invalid, not covered, bundled, not separately payable, statutorily excluded, or not reasonable and necessary in accordance with Medicare regulations or guidance.

Can MUE denials be appealed?

Many MUE denials are a result of incorrect billing. If you encounter a code with frequent denials due to an MUE, ensure the following: The denial is NOT MAI 2. These denials cannot be appealed.

What is the 76 modifier used for?

Modifier 76 Used to indicate a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service.

What is the difference between MUE and Mai?

An MUE Adjudication Indicator (MAI) of “1” indicates that the edit is a claim line MUE. The MUE value is an absolute date of service limit that may not be overridden or bypassed with a modifier. b. MUE edit limits with an MAI of “2” have been rigorously reviewed and vetted within CMS.

What does a 0 in an NCCI edit mean?

A modifier indicator of “0” indicates that an edit can never be bypassed even if a modifier is used. In other words, the Column 2 code of the edit will be denied. A modifier indicator of “1” indicates that an edit may be bypassed with an appropriate modifier appended to the Column 1 and/or Column 2 code.

What does MUE of 1 mean?

1. An MUE Adjudication Indicator (MAI) of “1” indicates that the edit is a claim line MUE. a. Appropriate use of NCCI modifiers (e.g., 59, 76, 77, 91, anatomic) may be used to report the same HCPCS/CPT code on separate lines of a claim.

https://www.youtube.com/watch?v=4giobygLnKQ

Which is an example of a Mue adjudication indicator?

This analysis resulted in the establishment of a MUE Adjudication Indicator (MAI) which specifies the type of MUE and the basis for the MUE. A MUE Adjudication Indicator is either a 1 (line edit), 2 (absolute date of service edit), or 3 (date of service edit).

What does Mue mean on Medicare claim form?

Note that each MUE has a “Medicare Adjudication Indicator” (MAI). This indicates whether the MUE is a line edit or a date of service edit. If it is a line edit, the MUE will be applied on a line basis. This may allow billing in excess of the MUE by using more than one line of the claim form.

Are there limits to the number of MUE edits?

MUE edit limits with an MUE Adjudication Indicator of “3” (Date of Service Edit: Clinical): a. It would be possible but medically highly unlikely that more units than the MUE value would ever be performed on the same date of service for the same patient.

What does Mai mean in a Mue ndicator?

“3” indicates a date of service edit and is the most common per day edit. An MAI. of “3” indicates an edit for which the MUE is based on clinical information such. as billing patterns, prescribing instructions, or other information.