ACR Achieves MUE Increase for 3D-Printed Add-on Codes

ACR^® successfully appealed to CMS to increase the National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUEs) for the add on codes for 3D printed anatomic models (0560T) and guides (0562T) after listening to members’ concerns about the values. CMS increased the MUE for CPT^® code 0560T from 1 unit to 5 units, and for code 0562T from 1 unit to 2 units.

MUEs are the maximum number of units of service a provider or supplier would report for a Healthcare Common Procedure Coding System (HCPCS)/CPT code for the same beneficiary on the same date of service in most appropriately submitted claims. If services are performed in excess of the MUE value, the claim will be denied, and an appeal must be submitted with documentation supporting medical necessity.

ACR in its appeal noted that the previous MUE value of 1 was not aligned with the code structure and did not reflect the clinical realities associated with complex surgical planning. Such procedures often require multiple distinct anatomical components, each necessitating separate segmentation, processing and printing, to adequately guide surgical decision making.

These revised MUE values are included in the April 1 Medicare NCCI MUEs.

Questions or comments may be directed to Maria Tran, ACR Director of Economics and Health Policy.