DME Medicare billing edit change effective April 1

03-29-2017

Effective April 1, 2017, Durable Medical Equipment (DME) services that exceed the Medically Unlikely Edits (MUE) will deny all units for a claim line(s). The MUE clinical edit associated with DME claim will align with the Centers for Medicare and Medicaid (CMS) criteria defined by MUE adjudication indicator.

Currently, if a provider bills multiple units on single or multiple lines of a claim form, and the total units exceed what is medically likely to have occurred on that date, the MUE limit may be partially paid up to the allowed units depending on how the provider billed.

After April 1, 2017, if the total units for a code exceeds MUE, then all units will be denied (instead of a partial payment).

Additional specific information about the MUE adjudication indicator edit criteria can be found in the CMS notice.