MUE (Medically Unlikely Edit)
An MUE is a CMS-defined cap on the units of a code allowed per patient per day; units above the cap are denied (CARC 151), and the denied units are recoverable when documentation supports them.
A Medically Unlikely Edit (MUE) is a limit — set by CMS and adopted by many payers — on the maximum number of units of a given code that are considered plausible for one patient on one day. Bill above the MUE and the excess units are denied, typically as CARC 151 ('information submitted does not support this many services'), while the units within the cap are paid. Like bundling, MUEs are part of correct-coding enforcement, and like bundling, they produce denials that are often recoverable. When the chart genuinely supports the higher number of units — a bilateral service, multiple lesions, a legitimately high dose — the denied units can be recovered with the right modifier and documentation. Some MUEs are 'date-of-service' edits that can be overridden with the proper modifier and supporting notes; others are absolute per-line caps. The practical issue is that MUE denials are partial: the claim pays for most of the units, so the short payment on the denied units is easy to overlook, the same way downcoding is. Catching them means comparing units billed to units paid and recognizing when the denied units are clinically justified rather than assuming the cap is final.
Volari flags the partial short-payments MUE denials create and recovers the denied units when the documentation supports them — the easily-overlooked money on claims that mostly paid.
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