July NCCI update adds sky-high MUE values for core E/M services

June 29, 2020
Medicare Web

CMS recently released updates to National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUE) for provider services. Effective July 1, the update will restore the MUEs that CMS deleted with an off-schedule revision and assign an MUE value of 24 to dozens of services.

Providers should note that CMS did not restore the 29,000 NCCI edits that were deleted by the previous April 7 update.

The July update resets the MUE values for 30 codes to their original values (prior to March 31), including an MUE of 1 for initial observation visits (99218-99220) and initial hospital visits (99221-99223). If a provider performs two of these services in-person or by telehealth for the same patient on the same day, a modifier adjudication indicator of 3 (Date of Service Edit: Clinical) will allow providers to appeal the denial.

Providers will find new MUEs for another 167 codes. For example, CMS assigned an MUE of 4 to subsequent observation visits (99224-99226) and subsequent inpatient visits (99231-99233). In addition, dozens of E/M codes now have 24 MUEs, including office visits (99201-99215) and home visits (99341-99350). That means a provider would be allowed to report up to 24 office visit services to the same patient on the same encounter date. CMS also gave an MUE of 24 to encounters performed online (99421-99423), or by audio-only telephone call (99441-99443).

Practices may continue to use the relaxed telehealth rules to report the 197 services, but the return of the MUEs and the new values are a sign that CMS is regularly evaluating utilization and the impact of the COVID-19 health emergency.