Centers for Medicare and Medicaid Services

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Author
Medicaid.gov
Description
Medically Unlikely Edits (MUEs) define for each HCPCS / CPT code the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service. Practitioner services also refers to ambulatory surgical centers. DME refers to provider claims for durable medical equipment. The CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B claims and Medicaid claims. NCCI procedure-to-procedure (PTP) edits define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported. The edits in this dataset are active for the dates indicated within. This file should NOT be used by state Medicaid programs as their edit file. Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. For more information, visit https://www.medicaid.gov/medicaid/program-integrity/ncci/index.html.
Category
Uncategorized
Tags
medically unlikely edits, hcpcs, cpt codes, ncci edits
Rating
Current value: 0 out of 5
Data Provided By
Centers for Medicare and Medicaid Services
Source Link
https://www.medicaid.gov/
License
Public Domain U.S. Government
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Size
  • 500x425

  • 760x646

  • 950x808

Custom Size

425x425 is the minimum size

The Socrata Open Data API (SODA) provides programmatic access to this dataset including the ability to filter, query, and aggregate data. For more more information, view the API docs for this dataset or visit our developer portal

API Endpoint:

Field Names:

Quarter Begin Date
quarter_begin_date
Category
category
HCPCS/CPT Code
hcpcs_cpt_code
MUE Value
dme_supplier
MUE Rationale
mue_rationale

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