CMS Sets Medically Unlikely Edit for Key Audiology Codes

The Centers for Medicare and Medicaid Services (CMS) has established a Medically Unlikely Edit (MUE) of two units per date of service for Current Procedural Terminology (CPT®) codes 92629, 92632, 92635, and 92637, which describe time‑based, add‑on professional services for hearing device candidacy evaluation, selection, fitting, and post‑fitting follow‑up.

For each of these codes, CMS has assigned:

• An MUE value of two, indicating that, under typical circumstances, no more than two 15‑minute add‑on units should be reported for a single beneficiary on a single date of service.
• An MUE Adjudication Indicator (MAI) of three, meaning that claims exceeding two units will be automatically denied but may be payable in rare, well‑documented cases when a Medicare contractor’s medical review confirms that the additional units are correctly coded and medically necessary.

This policy, effective April 1, 2026, applies to both practitioner and outpatient hospital claims. In practical terms, CMS is indicating that providers would usually report no more than 30 minutes (two units) of add‑on time for these services on a single date of service and should be prepared to support any higher utilization with clear, well‑documented clinical rationale.

In addition, providers should continue to follow applicable National Correct Coding Initiative (NCCI) policies, including medically unlikely edits and any relevant procedure‑to‑procedure or unit‑of‑service editing. For additional information, please visit here.