Medically unlikely edits (MUEs) are the daily limit placed by the Centers for Medicare & Medicaid Services (CMS) on billed CPT codes and are often used by private payers to reduce the likelihood of coding errors. With the assistance of the Section on Administration and Practice Management (SOAPM) and the Committee on Coding and Nomenclature (COCN), the Academy worked with CMS to update the MUEs associated with the vaccine administration codes 90460 and 90461 based on clinical rationale.
The updates are as follows:
- Effective April 1, 2017, the MUE for 90460 will go from 6 to 9
- Effective July 1, 2016, the MUE for 90461 will go from 5 to 8 (Since this update was published January 1, 2017 but was effective July 1, 2016, any denials since this date should be appealed.)
If you receive denials for MUEs, email the AAP coding hotline at firstname.lastname@example.org. (Full Article)