MUE

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February 5, 2015

Question:
We attended a coding course last week (non AAOS/non KZA) and were told that we could only report one unit of 20611 during an office visit because CMS had an MUE of “1” for this code.

Answer:
Ms. LeGrand explained that she had not heard of this and would research and post the answer. In reviewing the MUE edits from CMS, Ms. LeGrand verified that there is not an MUE of “1” for the injection codes, 20600-20611. Following the course, Ms. LeGrand researched the MUE list and found that while the new injection codes have a MUE, it is not “1”. The following table does show a MUE of 4 for each of the injections during the same session. Assuming medical necessity is present, documentation is present and the claim is submitted correctly, CMS will consider the injection codes 20600-20611 when submitted independently for each injection at a different location.

HCPCS/CPT CodePractitioner Services MUE ValuesMUE Adjudication IndicatorMUE Rationale
2060043 Date of Service Edit: ClinicalClinical: Data
2060443 Date of Service Edit: ClinicalClinical: CMS Workgroup
2060543 Date of Service Edit: ClinicalClinical: Data
2060643 Date of Service Edit: ClinicalClinical: CMS Workgroup
2061043 Date of Service Edit: ClinicalClinical: Data
2061143 Date of Service Edit: ClinicalClinical: CMS Workgroup