A Medically Unlikely Edit (MUE) for an HCPCS or CPT Code denotes the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service. For the DMEPOS Fee Schedule, the Division of Workers’ Compensation (DWC) has NOT adopted the application of MUEs.
If a claims administrator incorrectly denies a DME bill based on the practitioner services MUE, DaisyBill recommends you appeal this incorrect denial with a timely Second Review as follows:
“DME may not be denied based on the Practitioner Services MUE. The California DWC has not adopted the application of NCCI edits, including MUEs for the DMEPOS fee schedule. Please reprocess this line item.”
Explanation
From the DWC Website FAQ:
From DaisyBill, here's an example of the suggested language using our SBR Generator:
For more on MUEs in the context of DMEPOS, read Do NCCI Edits (such as MUEs) apply to the DMEPOS fee schedule?
Additional Information
DWC FAQ - About durable medical equipment (DME) dispensed by physician
DWC Official Medical Fee Schedule
DaisyBill Resources
Webinar: Request for Second Review
Webinar: SBR Strategy Kit, Part I
Webinar: SBR Strategy Kit, Part II
DaisyBill Solution
DaisyBill’s billing software integrates easy Second Bill Review submission seamlessly into our billing process. For more information about California’s workers’ comp electronic billing, book a demo and see how DaisyBill solves workers' comp billing problems.