Expedited Implementation of January 2026 NCCI PTP Edits for COVID Vaccine Administration

The Centers for Medicare & Medicaid Services (CMS) has identified an issue with National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits related to Current Procedural Terminology (CPT) code 90480 for COVID-19 vaccine administration.

Due to PTP edits implemented on October 1, 2025, claims are being incorrectly denied when COVID-19 administration and other vaccines are billed on the same day. To address this, CMS is expediting the implementation of the January 2026 NCCI PTP edits file-Quarterly Update to the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) Edits, Version 32.0, effective January 1, 2026.

Within 30 business days of implementation of the new 2026 files, Part B MACs shall perform the following actions:

  • Adjust claims for erroneously denied claims with dates of service on or after October 1, 2025, to allow payment, if there is no other reason to deny the claim.
  • Adjudicate appeals for the code with dates of service on or after October 1, 2025, to allow payment if there is no other reason to deny the claim.
Last Updated Nov 21 , 2025