CMS modifies Medicare Medically Unlikely Edit (MUE) Value for KEYTRUDA®

Merck has informed OSCO that the Medicare Medically Unlikely Edit (MUE) value has been modified for KEYTRUDA® (pembrolizumab).

The MUE for KEYTRUDA was modified effective July 1, 2020.

A list of quarterly Procedure-to-Procedure and MUE version update changes from CMS can be found here.

Payer coding and coverage requirements may vary or change over time, so it is important to regularly check with each payer as to payer-specific requirements. The use of this information does not guarantee payment or that any payment will cover your costs. You are solely responsible for determining the appropriate codes and for any action you take in billing.

You can find useful resources at

Before prescribing KEYTRUDA® (pembrolizumab), please read the accompanying Prescribing Information. The Medication Guide also is available.

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