CMS List of Medically Unlikely Edits for Ambulance Services
On October 1, 2016, the Centers for Medicare and Medicaid Services (CMS) updated its list of Medically Unlikely Edits (MUEs). The MEU program is designed to reduce the paid claims error rate for Part B claims. The program operates by estimating the maximum number of units of service that a provider/supplier would report under most circumstances for a single beneficiary on a single date of service. A claim that submits units of service in excess of this threshold will typically be denied by the Medicare Administrative Contractor.
For additional information on the CMS Medically Unlikely Edit Program, click here.
Effective October 1, 2016, claims for ambulance services will be subject to the following MUE edits:
| HCPCS Code | MUE Threshold |
| A0425 (Ground Ambulance Mileage) | 250 |
| A0426 (Ground Ambulance, ALS Non-Emergency) | 2 |
| A0427 (Ground Ambulance, ALS Emergency) | 2 |
| A0428 (Ground Ambulance, BLS Non-Emergency) | 4 |
| A0429 (Ground Ambulance, BLS Emergency) | 2 |
| A0430 (Air Ambulance, Fixed Wing) | 1 |
| A0431 (Air Ambulance, Helicopter) | 1 |
| A0432 (Ground Ambulance, Paramedic Intercept) | 1 |
| A0433 (Ground Ambulance, ALS-2) | 1 |
| A0434 (Ground Ambulance, Specialty Care Transport) | 2 |
| A0435 (Air Ambulance, Fixed Wing Mileage) | 999 |
| A0436 (Air Ambulance, Helicopter Mileage) | 300 |
2016, Healthcare Common Procedure Coding System (HCPCS), Medically Unlikely Edits (MUEs)
