Knowledge Base Article

Q:
An article in a recent Wednesday@One talked about the medically unlikely edits (MUEs) and the newly published MUE Adjudication Indicators (MAIs). In the past, CMS did not publish all MUE values – some were maintained as confidential. Does the implementation of the MAIs mean that all MUE values are now published? 

A:

No, even with the implementation of MAIs, not all MUEs and their corresponding MAIs are published. This is explained best in Transmittal 1421. Below is the excerpt from Transmittal 1421. Transmittals are technical directions to the Medicare Administrative Contractors (MACs) so the organization referenced in the quote refers to the MACs.

“For HCPCS codes with confidential MUEs (i.e., Publication Indicator = 0), the MAI levels may not be published or shared with anyone outside of your organization. All other MAIs for non-confidential MUEs can be published or shared.”