CMS Issues Transmittal to Update Use of Medically Unlikely Edits

The Centers for Medicare and Medicaid Services has issued Transmittal 617, which revises the use of medically unlikely edits, specifically modifier -55 (postoperative management only).

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Transmittal 617 rescinds and replaces Transmittal 178, Change Request 5402, dated Dec. 8, 2006, and changes the file format and some of the process and is denying Fiscal Intermediary Shared System lines.

The change to modifier indicates “Contractors may process claim service lines that exceed MUE limits and also contain a 55 modifier in a manner such that the MUE audit will not systematically deny the service line,” according to the transmittal. Changes go into effect on April 1, 2010.

For complete changes and further information, read Transmittal 617 (pdf).

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