Coalition Prompts Medically Unlikely Edit Policy Change

After receiving reports from providers that many health plans are utilizing the Centers for Medicare & Medicaid (CMS) MEDICARE values for Medically Unlikely Edits (MUEs) to set per-patient per-day limitations on ABA services, the ABA Coding Coalition made a request of payers nationwide to utilize the CMS MEDICAID MUEs, which allows increased units of service for assessment code 97151 and destructive behavior code 0373T. This recommendation is consistent with our Model Coverage Policy for Adaptive Behavior Services. For more information on MUEs, click here.