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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Medically Unlikely Edits 

Medically unlikely edits for physical, occupational, and speech therapy services. Practitioner Edits apply to therapists in private practice and employed by physician groups. Hospital Edits apply to therapists working in facilities such as outpatient hospitals, CORFs, outpatient rehabilitation, and SNFs.

MUE Edits are updated quarterly. 

Updated: June 1, 2023

Medically Unlikely Edits (MUE) Guide

Practitioner Edits 

    • Physical Therapists
    • Occupational Therapists
    • Speech-Language Pathologists

Hospital Edits

PTP edits are applied to Types of Bills (TOBs) subject to the Outpatient Code Editor (OCE) for OPPS. These edits are applied to:

    • Outpatient hospital services and other facility services;
    • Therapy providers (Part B Skilled Nursing Facilities (SNFs));
    • Comprehensive outpatient rehabilitation facilities (CORFs);
    • Outpatient physical therapy and speech-language pathology providers (OPTs); and
    • Certain claims for home health agencies (HHAs) billing under TOBs 22X, 23X, 75X, 74X, 34X.

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Therapy Comply is a healthcare compliance firm that seeks to bring high quality web-based compliance guidance and one-on-one consulting services to small and medium size physical, occupational, and speech therapy practices.

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