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Locate Guidelines on the CMS Website

A procedure can have other policies or guidelines besides an LCD or NCD. The CMS website has a wealth of information.

Step 1: Search the CMS Internet Only Manuals (IOM)

The CMS IOM displays day-to-day operating instructions, policies, and procedures that are based on statutes, regulations, guidelines, models, and directives. They are a valuable source of Medicare information.

Image of the CMS Internet Only Manuals (IOMs)

 

Step 2: Search for MLN Matters® Articles

These articles explain Medicare policy in an easy-to-understand format. They focus on coverage, billing, and payment rules for specific provider types. They are prepared with assistance from clinicians, billing experts and CMS subject matter experts.

Image of the CMS 2026 Transmittals and MLN matters articles

Step 3: Review the Medically Unlikely Edits (MUE) edits 

MUEs

An MUE is a maximum number of units of service allowable under most circumstances for a single CPT/HCPCS code billed by a provider on a single date of service for a single patient. MUEs were developed to reduce the paid claims error rates based on anatomical consideration, CPT instructions, CMS policies and clinical judgment. MUEs are updated quarterly. 

Navigate to the MUE edits from the left navigation bar on the NCCI page. 

Image of the CMS Medically Unlikely Edits

There are three types of MUE edit files listed under related downloads, DME supplier services, facility outpatient hospital services and practitioner services. Select the appropriate file. 

The MUE table will open in another window. 

Image of the MUE edit table.

Components of the MUE Table

  • Column A contains the CPT/HCPCS codes.
  • Column B is the MUE value representing the maximum units of service.
  • Column C is the MUE Adjudication Indicator (MAI).
    • MAI 1 is a line level edit which means you can bill up to the MUE per line of service. May require modifiers to distinguish.
    • MAI 2 is an absolute date of service edit which means CMS gives no instances in which a higher value would be correct and payable. Appeals will not overturn the decision even with documentation. 
    • MAI 3 is a date of service edit which means it can be appealed with additional documentation of medical necessity to support reported units. 
  • Column D is the MUE rationale.

Continue to View the LCDs. 

Back to the main FastTrack to Medicare coverage policies