December 31, 2007

ACR Radiology Coding Source™ Nov-Dec 2007

Medically Unlikely Edits

The Centers for Medicare & Medicaid Services (CMS) recently implemented a new system of edits which cap the number of services payable on a specific date. Initially termed Medically Unbelievable Edits, CMS has renamed these Medically Unlikely Edits (MUEs). Although confidentiality restrictions imposed by CMS preclude the ACR from disclosing details, the ACR is committed to ensuring that these edits do not impede the delivery of good medical care to Medicare beneficiaries. 

The ACR is interested in learning how MUE edits are being implemented locally and nationally. In addition, the ACR is interested in better understanding the impact on radiology practices and, therefore, would encourage practices to forward information to the College regarding specific day of service limitation denials. If you identify payment denials based on MUEs, this information will be most useful to us. 

Although the ACR is prohibited by CMS from disclosing confidential material it received during the MUE process, no such restriction exists for information received from ACR members. As such, this information will be extremely important to radiology practices across the country, and the ACR hopes to use this knowledge to identify inappropriate edits which unnecessarily restrict care. 

The ACR is working with the American Medical Association and many other specialty societies to ensure that these restrictions on health care payment are subject to the same public disclosure and scrutiny as all other restrictions placed upon public health funds. Your assistance will greatly help us in this mission. 

If you are familiar with MUE edits impacting your practice, please submit the following via email to Gloria Garcia at For your reference, a commonly used “remark code” utilized by Medicare to identify an MUE claim denial is N362 The number of Days or Units of Service exceeds our acceptable maximum.” 

CPT code: 
Utilization limit: 
Statement of denial: