In our July 12, 2021 Newsletter, we reported that a new regimen was approved by the FDA for Cetuximab that exceeded the current Medically Unlikely Edits. We wrote a letter to CMS asking that it be raised from 120 units to 150 units and the new October 1 MUE tables reflect the increase!!!
Facilities who had removed any additional units that exceeded the MUE should evaluate whether re-billing would be appropriate. If the claims are re-billed with the higher units and dates of service prior to October 1, 2021, we recommend submitting a paper claim with medical record documentation that the drug regimen was following the newly approved dosing instructions.
We’ve provided our original newsletter for background information!