September 22, 2023

CMS to Modify Cardiac MRI for Velocity Flow Mapping MUE Value

The Centers for Medicare and Medicaid Services (CMS) responded favorably to a multi-medical society appeal to increase the Medically Unlikely Edit (MUE) value of CPT® code 75565 (Cardiac magnetic resonance imaging for velocity flow mapping (list separately in addition to code for primary procedure) from 1 to 4. The MUE value is the maximum units of service that a provider may report under most circumstances for a single beneficiary on a single date of service.

In a joint appeal, the American College of Radiology® (ACR®), American Roentgen Ray Society, Association of University Radiologists, Radiologic Society of North America and Society for Cardiovascular Magnetic Resonance argued that the MUE for CPT code 75565 should be increased from 1 to 4. The societies disagreed with the MUE value of “1” for code 75565 when reported more than once at the same session or on the same day. Code 75565 was established to report cardiac MRI for velocity flow mapping, it is an add-on code and should be reported in conjunction with the cardiac magnetic resonance imaging for morphology and function codes 75557, 75559, 75561 and 75563.

After reviewing the comment letter and participating in a virtual meeting with the specialty societies, CMS decided to temporarily increase the Medicare MUE and the Medicaid National Correct Coding Initiative (NCCI) MUE to 4 and change the MUE Rationale to “Society Comment.

CMS expected to implement this change in the Jan. 1 edit files, but most recently communicated that it will take effect Oct. 1.

Refer to the Practitioner Services MUE Table and CMS NCCI webpage for additional information or contact Maria Tran, ACR Director of Economic Policy.