What the value catches Copy link
An MUE is set to catch gross errors, such as a misplaced decimal or a keying mistake in the units field. Medically necessary units can occasionally exceed it, so an excess alone does not prove the billing was wrong.
The adjudication indicator Copy link
How an excess is handled depends on the MUE adjudication indicator (MAI). An MAI of 1 is a claim-line edit: each line is checked on its own. Reporting the code on separate lines with appropriate modifiers can carry medically necessary units above the limit, though contractors restrict those modifiers for some codes. MAIs of 2 and 3 are date-of-service edits: units for the code are summed across all lines on that date before the check. The two differ in what a contractor may do about an excess. An MAI of 2 is absolute, and CMS instructs contractors that overriding it would be contrary to CMS policy. An MAI of 3 rests on clinical benchmarks, and a contractor may bypass it on evidence that the units were provided, correctly coded, and medically necessary. Any MUE denial may be appealed, whatever the indicator. The indicator governs the bypass, not the right to appeal.
| MAI | Edit type | How excess units are handled |
|---|---|---|
| 1 | Claim-line edit | Each line checked separately; appropriate modifiers on separate lines allow medically necessary units above the limit |
| 2 | Date-of-service edit, absolute | Units summed across all lines for that code on that date; CMS instructs contractors that an override would be contrary to CMS policy |
| 3 | Date-of-service edit, clinical benchmarks | Units summed the same way, but a contractor may bypass the edit on evidence the units were provided, correctly coded, and medically necessary |
A ceiling, not a target Copy link
CMS publishes most MUE values but keeps some confidential, so a code with no published MUE may still have a limit. A published value is not a target either: billing right up to it says nothing about whether the coding was correct. The limit only screens out implausible unit counts.
Check a code pair and its unit limits Copy link
Enter a code to see its MUE limit and how many NCCI edits it’s in. Add a second code to check whether the two can be billed together on the same day.
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NCCI Q4 2026 edit files
93000 is in 6,211 active procedure-to-procedure edits: 10 no modifier can bypass, 6,201 an NCCI-associated modifier can.
- 93000 MUE limit
- 3 units per day
- MAI 3: Date-of-service edit, clinical benchmarks. Units summed the same way, but a contractor may bypass the edit on evidence the units were provided, correctly coded, and medically necessary.
- 99213 MUE limit
- 2 units per day
- MAI 3: Date-of-service edit, clinical benchmarks. Units summed the same way, but a contractor may bypass the edit on evidence the units were provided, correctly coded, and medically necessary.
93000 + 99213: The Q4 2026 NCCI edit files we hold list no active procedure-to-procedure edit for this pair. Other Medicare coverage and billing rules can still apply.
This checker covers NCCI procedure-to-procedure edits only—edits that modifier 59 or a more specific X{EPSU} modifier can bypass. It does not cover modifier 25. If 93000 is an evaluation and management visit billed the same day as a separately identifiable procedure, modifier 25 usually matters instead. That decision depends on documentation, not this checker. Source: CMS National Correct Coding Initiative (NCCI) Edits (Q4 2026).
See every current NCCI pair for 93000
Edits and limits from CMS’s NCCI files for practitioners. Whether a modifier fits a claim depends on the documentation, which this lookup doesn’t judge.
Frequently asked Copy link
Does exceeding the MUE always deny the claim?
Exceeding a claim-line MUE denies all units on that line; exceeding a date-of-service MUE denies all units for the code on the current claim. What you can do next depends on the adjudication indicator. On a claim-line edit (1), reporting the code on separate lines with appropriate modifiers can carry medically necessary units above the limit. CMS instructs contractors not to override an absolute date-of-service edit (2). A contractor may bypass a clinical date-of-service edit (3) on evidence the units were provided, correctly coded, and medically necessary.
Can an MUE denial be appealed?
Yes. CMS states that denials due to claim-line or date-of-service MUEs may be appealed to the local claims processing contractor, whatever the adjudication indicator. The indicator decides whether a contractor may bypass the edit, not whether you may appeal the denial.
Does a code without a published MUE have no unit limit?
Not necessarily. CMS publishes most MUE values but keeps some confidential for CMS and contractor use. Other edits, like PTP, may also apply.
Sources Copy link
Written from primary CMS sources—see how we source, compute, and verify everything on this site.
- An MUE is the maximum units of service reported for a HCPCS/CPT code on the vast majority of appropriately reported claims by the same provider for the same beneficiary on the same date of service. —CMS Medicare NCCI Policy Manual (2026)
- An MAI of 1 marks a claim-line MUE, while an MAI of 2 or 3 marks a date-of-service MUE. —CMS Medicare NCCI Policy Manual (2026)
- On a claim-line MUE, appropriate use of CPT modifiers to report the same code on separate lines lets each line be adjudicated separately against the limit, though contractors have rules restricting those modifiers for some codes. —CMS Medicare NCCI Policy Manual (2026)
- An MAI of 2 is an absolute date-of-service edit, and CMS instructs claims processing contractors that overriding it during processing, reopening, or redetermination would be contrary to CMS policy. —CMS Medicare NCCI Policy Manual (2026)
- An MAI of 3 rests on clinical benchmarks, and a contractor with evidence that excess units were actually provided, correctly coded, and medically necessary may bypass the edit. —CMS Medicare NCCI Policy Manual (2026)
- Denials due to claim-line MUEs or date-of-service MUEs may be appealed to the local claims processing contractor. —CMS Medicare NCCI Policy Manual (2026)
- Most MUE values are published on the CMS MUE webpage, but some are not published and are confidential. —CMS Medicare NCCI Policy Manual (2026)
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