Not Separately Payable/National Correct Coding Initiative - JF Part B

Common Reasons for Message

• Combination of codes billed on same date of service by same provider may not be appropriately paired together due to National Correct Coding Initiative (NCCI) Edits
  • Payment for service billed is bundled into payment for another service performed that day
  • It is unusual for services billed to be performed together
• Modifier used to unbundle is on incorrect code or incorrect modifier was used

Next Step

• Verify code set is appropriate to be billed together
• Submit Appeal request to add modifier, if appropriate
  • See Appeals webpage for instructions on how to submit a Reopening or Redetermination
• Providers may not bill patient for NCCI edit denials
  • Denial is based on incorrect coding
  • Providers should not complete an ABN for NCCI edits

Claim Submission Tips

• Review NCCI Coding Edits prior to submitting claim to determine if codes are appropriately paired
  • View How to Use Medicare NCCI Tools
• When appropriate, modifier to identify separately identifiable service should be appended to Column 2 code
  • Modifier Indicator "0" - there are no circumstances in which both procedures of a code pair should be paid; modifier is not allowed for NCCI purposes
  • Modifier Indicator "1" - modifiers associated with NCCI are allowed with this code pair when appropriate
  • Modifier Indicator "9" - NCCI edit does not apply to this code pair; edit for code pair was deleted retroactively