Observation Hours Over MUE

Quest ion:

We have been billing non-covered observation hours on our claims when applicable. All of them seem to be billing OK, with the exception of Traditional Medicare The non-covered observation hours are on a separate line with a modifier attached (G0378-GY). Could you please advise on this situation?

Answ er:

A Medicare beneficiary should not be charged for observation hours that exceed the Medically Unlikely Edit (MUE) of 72 hours Medicare cautions that there is a difference between non-covered and nonpayment and that Medicare covers all medically reasonable and necessary observation services.

Medicare Administrative Contractor Novit as suggests hospitals bill hours beyond the MUE under revenue code 0762 with no HCPCScode with charges in the non-covered fields.