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Search CMS' NCCI Medically Unlikely Edits (MUEs) API

Source: R/codex_mue.R
codex_mue.Rd

codex_mue() allows you to search CMS' NCCI Medically Unlikely Edits (MUEs) API.

Usage

codex_mue(
  category = NULL,
  hcpcscpt_code = NULL,
  mue_value = NULL,
  mue_rationale = NULL,
  clean_names = TRUE,
  lowercase = TRUE
)

Source

Centers for Medicare & Medicaid Services

Arguments

category

Practitioner Services, Outpatient Hospital Services, DME Services

hcpcscpt_code

HCPCS code

mue_value

integer. MUEs define the maximum units of service (UOS) that a provider would report for each HCPCS / CPT code under most circumstances for a single beneficiary on a single date of service.

mue_rationale

Choices:

  • "Anatomic Consideration"

  • "Clinical: Medicare Data"

  • "Code Descriptor / CPT Instruction"

  • "Nature of Service / Procedure"

  • "CMS Policy"

  • "Nature of Equipment"

  • "Inpatient Procedure"

  • "Nature of Analyte"

  • "CMS NCCI Policy"

  • "Prescribing Information"

  • "Clinical: CMS Workgroup"

  • "Drug Discontinued"

  • "Clinical: Medicaid Data"

  • "Clinical: Society Comment"

  • "Nature of Service/Procedure"

  • NA

  • "Clinical: Data"

  • "does NOT appear on published file"

clean_names

Clean column names with janitor's clean_names() function; default is TRUE.

lowercase

Convert column names to lowercase; default is TRUE.

Value

A tibble containing the search results.

Details

Medically Unlikely Edits (MUEs) define for each HCPCS / CPT code the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service. Practitioner services also refers to ambulatory surgical centers. DME refers to provider claims for durable medical equipment. The CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B claims and Medicaid claims. NCCI procedure-to-procedure (PTP) edits define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported. The edits in this dataset are active for the dates indicated within. This file should NOT be used by state Medicaid programs as their edit file. For more information, visit https://www.medicaid.gov/medicaid/program-integrity/ncci/index.html.

Note

Update Frequency: Quarterly

Examples

if (FALSE) {
codex_mue(category = "Practitioner Services")
codex_mue(hcpcscpt_code = "G0121")
codex_mue(mue_value = "1")
codex_mue(mue_rationale = "Anatomic Consideration")
}