KMAP BULLETIN: UPDATED - NCCI/MUE Editing – January 2025

Date: 02/13/25

Effective with processing date of January 1, 2025, additions, revisions, and deletions related to first quarter 2025 National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) will be made according to the Medicaid quarterly files.

UPDATED: On January 29, 2025, Center for Medicare and Medicaid Services (CMS) issued replacement files for NCCI Medicaid MUEs for Healthcare Common Procedure Coding System (HCPCS) code J0911 to change the MUE value from 50 to 60, effective date January 1, 2025. Reference the NCCI page on the on the Medicaid website for additional information. UPDATED: Note: No additional action is needed from providers. The Kansas Medical Assistance Program (KMAP) will reprocess any impacted claims for additional payment.

Note: The effective date of the policy is January 1, 2025. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.