NCCI Edits (such as MUEs) and the DMEPOS Fee Schedule

NCCI edits, such as medically unlikely edits (MUEs), do not apply to the DMEPOS fee schedule. In fact, none of the physician fee schedule billing rules apply to the DMEPOS fee schedule, because the latter is not part of the physician fee schedule.

This means that claims administrators cannot use MUE as a reason to deny or discount reimbursement for DME dispensed by a provider.

From the DWC Website FAQ:

Workers’ Comp DME Codes

Division of Workers’ Compensation Websites

DWC FAQ - About durable medical equipment (DME) dispensed by physician

DWC Official Medical Fee Schedule

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