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MUE lookup: units per date of service by code

Enter any HCPCS Level II or CPT code to see the CMS Medically Unlikely Edit for practitioner, facility outpatient and DME settings, with the adjudication indicator that decides whether an over-limit denial can be appealed. Searches run in your browser; nothing is stored.

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective

Example: J9271 (pembrolizumab, 1 mg)

A worked example of what the lookup returns: pembrolizumab is limited to 400 units (400 mg) per date of service in both practitioner and facility settings under a clinical (MAI 3) edit, and to zero units for DME suppliers.

MUE values for HCPCS J9271 in the 2026 Q4 tables
SettingMUEMAI
Practitioner services4003 · date of service edit: clinical
Facility outpatient hospital4003 · date of service edit: clinical
DME supplier03 · date of service edit: clinical

See the full J9271 reference page for the ASP limit, NDC billing units and coverage articles behind the same code.

How MUEs are applied

Medicare Administrative Contractors test every claim line against the MUE for its code and setting. For MAI 1 edits the test is per line, so units can legitimately be split across lines with modifiers such as 59, 76, 91 or the anatomic modifiers when the documentation supports distinct services. For MAI 2 and 3 edits the contractor sums all units for the code across the date of service, so splitting lines does not help; MAI 3 denials can be appealed with clinical documentation, MAI 2 denials almost never. The denial itself arrives as CARC 151 with remark N362. Drug codes most often exceed their MUE through unit-conversion errors between the NDC package and the HCPCS billing unit, which the HCPCS drug code pages show per code.

Frequently asked questions

What is a Medically Unlikely Edit?

An MUE is the maximum number of units of service that CMS considers reasonable for one HCPCS or CPT code on one date of service for one patient. Units above the limit deny with CARC 151 and remark N362.

What do the adjudication indicators mean?

MAI 1 is a claim-line edit: each line is tested separately, so documented separate services can be reported on another line with an appropriate modifier. MAI 2 is a date-of-service policy edit based on statute, regulation or anatomy, and appeals rarely succeed. MAI 3 is a date-of-service clinical edit that can be paid on appeal with documentation of medical necessity.

Why does a code show no MUE?

CMS publishes MUEs for most codes but withholds some values as confidential and applies them without publication. A missing value does not mean unlimited units.

How current is this tool?

It uses the 2026 Q4 practitioner, facility outpatient hospital and DME supplier tables effective October 1, 2026. CMS updates MUEs quarterly; the next release is January 1, 2027.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.

Disclaimer

MUE values are reproduced from the CMS tables as an operational reference. Payers may apply additional unit limits. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Not legal, clinical or billing advice.