Author Topic: Medically Unlikely Edit for ESRD Equipment  (Read 1222 times)


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Medically Unlikely Edit for ESRD Equipment
« on: September 12, 2015, 12:55:40 PM »

I have an MUE denial for HCPCS E1510 and E1590 (dialysis machines used for treatment of ESRD patients 3X a week) with Medicare and when I looked it up these are what I found: 

MUE Value = 0
MUE Adjudication Indicator =  3 Dates of Service Edit: Clinical

Does this mean these machines are not covered at all?  OR,  Does this mean I can only bill once every 3 dates of service?  My client is a home health agency providing staff-assisted in-home dialysis only. They provide the machines to the patient as a rental.

Any info you can share is greatly appreciated.



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Re: Medically Unlikely Edit for ESRD Equipment
« Reply #1 on: September 13, 2015, 01:26:36 PM »
From the information given I am not sure but I believe that it is something in the billing, not that it is not a covered service.  Have you tried calling the DME carrier and asking for an explanation?  They can usually point you to an LDC or NDC that is helpful.
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