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What Is an MUE?
A Medically Unlikely Edit (MUE) is the most units of a code that one provider would report for one patient on one date of service. CMS sets MUEs as part of the National Correct Coding Initiative (NCCI). If your claim goes over the limit, the extra units are denied.
CMS has separate MUE tables for practitioners, hospital outpatient departments and DME suppliers, and it updates them every quarter: January, April, July and October. This tool uses the tables that took effect on October 1, 2026. Medicaid programs use their own NCCI tables.
The Three MUE Types (MAI)
Every MUE has an adjudication indicator (MAI). It tells you how the limit is applied, and whether you can do anything when you really gave more units.
| MAI | How the limit works | If you gave more units |
|---|---|---|
| 1: Line edit | The limit applies to each claim line | Report the extra units on separate lines with the right modifier, such as 76, 77, 91, 59 or XS, or RT and LT |
| 2: Date of service, policy | All lines for that code on that day are added up | This is a firm rule. Extra units are not paid, and appeals rarely work unless the edit is wrong |
| 3: Date of service, clinical | All lines for that code on that day are added up | You can appeal with records that show the extra units were medically needed |
Common MUE Values (October 2026)
| Code | Practitioner MUE | Hospital outpatient MUE | Type |
|---|---|---|---|
| 96372 | 4 | 5 | Clinical (3) |
| 97110 | 6 | 8 | Clinical (3) |
| 99213 | 2 | 2 | Clinical (3) |
| 36415 | 2 | 2 | Clinical (3) |
| 85025 | 2 | 4 | Clinical (3) |
| 93000 | 3 | 3 | Clinical (3) |
| 20610 | 2 | 2 | Clinical (3) |
| 17000 | 1 | 1 | Policy (2) |
| J1100 | 120 | 120 | Clinical (3) |
| J3420 | 1 | 1 | Clinical (3) |
A value of 0 means Medicare does not pay that code for that type of provider. For example, practitioners have an MUE of 0 for DME items that only DME suppliers can bill.
How to Bill Units Over an MUE
- Check the MAI first. Only MAI 1 lets you split units across lines with modifiers.
- Use the right modifier for MAI 1. Use RT and LT for the two sides of the body, 76 or 77 for a repeat procedure, and 91 for a repeat lab test. See our modifier guides.
- For MAI 3, document the reason. If you gave more units, keep notes that show why, and be ready to appeal.
- For MAI 2, do not bill over the limit. The limit comes from the code definition or CMS policy.
- Drugs are billed by dose units. Check the unit in the code description with our NDC units calculator.
MUE Denials
Units over an MUE are denied on that line, often with remark code N362 (the number of days or units exceeds the acceptable maximum). Unit and frequency problems also show up as CO-151. Fix the units, use a correct modifier for line edits, or appeal with records for clinical edits.
Source: CMS Medicare NCCI MUE tables for practitioner, outpatient hospital and DME supplier services, effective October 1, 2026. CPT codes are copyright of the American Medical Association; this tool shows code numbers and CMS limits only.
Frequently Asked Questions
Written by Hassan Raza Awan
Founder — LegitMedBilling & IT Solutions
Hassan has 4+ years of hands-on U.S. medical billing experience — working claims, denials, credentialing, and payer follow-up for practices across the United States. Every guide he publishes is written from real remittances and payer behavior, not theory.
Billing injections? Our CPT 96372 guide covers units, modifier 25 and the 99211 rule. Check units and every other box on a claim with our CMS-1500 claim checker. Billing therapy units? Count them with our 8 minute rule calculator.
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