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We submitted a claim for Epoetin (an injection) (EPO) for an End Stage Renal Disease (ESRD) patient with units over 400,000 and it has been returned. Can we report units over the MUE as non-covered?

April 26, 2017claim disease EPO epoetin ESRD injection renal Stage submitted

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We submitted a claim for Epoetin (an injection) (EPO) for an End Stage Renal Disease (ESRD) patient with units over 400,000 and it has been returned. Can we report units over the MUE as non-covered?

2 Answers

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The Medically Unlikely Edit (MUE) for EPO is 400,000 units. Claims reporting units in excess of the MUE will be returned because it is seen as a typographical error. You cannot bill for units in excess of the 400,000 limitation.

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The Medically Unlikely Edit (MUE) for EPO is 400,000 units. Claims reporting units in excess of the MUE will are returned because it is seen as a typographical error. You cannot bill for units in excess of the MUE.