Medically Unbelievable Units Not a Worry- For Now

The Centers for Medicare and Medicaid Services (CMS) were due to implement an additional restriction on the reporting of units of service that was to begin on July 1st. The CMS has decided to not to use the “Medically Unbelievable Edits” (MUEs) that would have restricted the units of service you could report on your medical billing claims.

Based on concerns from physicians and medical billing and coding professionals alike, the CMS has pulled the planned implementation of this program for further review. This change to MUEs reimbursements would have affected roughly 1,000 laboratory and pathology CPT/HCPCS codes.

The MUEs would have limited the number of times you could bill a particular code for the same patient on the same day, and you would not have been able to use a modifier to override the edit. This would have resulted in greatly reduced revenues for many practitioners.

Two examples of commonly used medical billing codes that would have been affected include:
* 88305 (Level IV — Surgical pathology, gross and microscopic examination) — MUE limit proposal: two procedures.
* 88342 (Immunohistochemistry [including tissue immunoperoxidase], each antibody) — MUE limit proposal: four procedures.

This MUE limitation stay of implementation isn’t permanent; the CMS may try to implement this restriction in the future.

View all Articles by: Melissa Clark, CCS-P