Medically Unlikely Edits: Providers Must Bill for Individual Dates, Instead of Span Dating

Highmark applies Medically Unlikely Edits (MUEs) to submitted claims to ensure members receive appropriate, cost-efficient care based on evidence-based, clinical guidelines. Using MUEs, Highmark has detected an increasing number of claims with procedure codes being span dated (or range dated), which results in processing errors.

Effective March 1, 2026, Highmark’s claim systems will require professional providers to submit all HCPCS procedure codes with individual dates of service vs. a span date. This action will ensure that providers follow prior guidance and correct coding principles in claim submission.  

Span-dated claims that are subject to MUEs will be rejected or denied by Highmark.

Background on MUEs

Highmark follows the National Correct Coding Initiative (NCCI) guidelines created by the Centers for Medicare and Medicaid Services (CMS). MUE edits are applied to claims based on the values posted by the CMS. 

Highmark reserves the right to apply MUE edits outside of the CMS values when it is deemed clinically appropriate or use statistical methods to determine MUEs when no industry standard MUEs are available.

For more information, see Reimbursement Policy (RP)-035 Correct Coding Guidelines.