NCCI National Correct Coding Initiative
CMS's program of automated edits — procedure-to-procedure edits and medically unlikely edits — that prevent improper payment for code combinations and units.
The National Correct Coding Initiative (NCCI) is a CMS program designed to promote correct coding and prevent improper payment in Medicare Part B claims and, under federal law, in Medicaid.
Main components
- Procedure-to-procedure (PTP) edits identify pairs of HCPCS/CPT codes that generally should not be reported together for the same patient on the same date by the same provider. Each edit has a modifier indicator (0, 1 or 9) showing whether an NCCI-associated modifier may bypass it.
- Medically unlikely edits (MUEs) set a maximum number of units of service for a code per patient per date (or per claim line).
- The NCCI Policy Manual explains the coding principles behind the edits, chapter by chapter.
Update cycle
NCCI edits are updated quarterly. Medicare and Medicaid maintain separate edit files, and Medicare has separate PTP tables for practitioner and hospital outpatient services.
Compliance
Modifiers such as 59 and XE, XS, XP and XU may bypass a PTP edit only when documentation supports a separate and distinct service. Inappropriate modifier use is a recurring audit finding. Read our full guide: NCCI edits explained.