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MUEs Don't Apply to DME for Workers' Comp

October 2, 2014 by Catherine Montgomery

There’s been a fair amount of confusion so let’s make this plain: medically unlikely edits (MUEs) do NOT apply to work comp durable medical equipment (DME) bills.

On 9/16/2014 the DWC issued a newsline explaining that MUEs should not be used when adjudicating DME. In other words, claims administrators cannot use MUEs as a reason to deny or discount reimbursement for DME dispensed by a provider.

This is because the DMEPOS is a separate and different fee schedule from the the Physician Fee Schedule, so Physician Fee Schedule billing rules Do NOT Apply to the DMEPOS Fee Schedule.

National Correct Coding Initiative Edits (NCCI edits), including MUEs, only apply to the Physician Fee Schedule.

Additionally, I’d like to point out that even though the DWC released a newsline about this issue last month, the prohibition against MUE edits has been in effect since 1/1/2014; it is NOT a new or recent development.

For more information on the rules and regulations of work comp, visit DaisyBill's Webinar Library, a free workers' comp resource:

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