National Correct Coding Initiative (NCCI)

The purpose of the NCCI Procedure-to-Procedure (PTP) edits is to prevent improper payment when incorrect code combinations are reported. The NCCI contains one table of edits for physicians/practitioners and one table of edits for outpatient hospital services. The Column One/Column Two Correct Coding Edits table and the Mutually Exclusive Edits table have been combined into one table and include code pairs that should not be reported together for a number of reasons explained in the Coding Policy Manual. See the CMS NCCI Coding Edits to determine if the service being submitted is bundled with another service.

Column One/Column Two Correct Coding Edits Table

Column 1: Comprehensive or major code

Column 2: Secondary or component code

In Existence Prior to 1996: * indicates edit was in effect prior to 1996

Effective Date: Indicates effective date of the edit

Deletion Date: Indicates deletion date of the edit, if applicable

Modifier: Indicates if use of a modifier is permitted

  • 0: Codes should never be reported together by the same provider for the same beneficiary on the same date of service; if reported on the same date of service, the column one code is eligible for payment and the column two code is denied
  • 1: Codes may be reported together only in defined circumstances by use of NCCI-associated modifier
  • 9: Not applicable

Exceptions to NCCI bundling must be documented in the patient's medical records and submitted with the appropriate modifier(s). These ‘exception' modifiers must be submitted with the correct CPT or HCPCS code. Examples of modifiers used to indicate a separate procedure, different organ or anatomic clarity are (not all-inclusive list):

  • Modifier 59: Distinct or independent service performed on the same day (or XE, XS, XP, XU)
  • RT and LT: Right and left side of body
  • E1-E4: Eyelid
  • FA, F1-F9: Hand modifiers
  • TA, T1-T9: Feet modifiers

Modifier 59 or XE, XP, XS, XU should not be appended to:

  • Evaluation and Management (E/M) service – to report a separate and distinct E/M service with a non-E/M service performed on the same date, modifier 25 is used
    • Includes ophthalmology codes 92012-92014
  • Weekly radiation code 77427 Radiation treatment management, 5 treatments

When a provider or supplier submits a claim for any of the codes specified above with the 59 or XE, XP, XS, XU modifier, the claim will be processed as if the modifier were not present.

PTP Edit Rationale: Indicates the reason for the correct coding edit. CMS provides rationale for the edit in the NCCI General Correspondence Language and Section-specific Examples (for NCCI Procedure to Procedure (PTP) Edits and MUEs.

Standard Preparation/Monitoring Services for Anesthesia
Anesthesia services require certain services to prepare patient prior to administration of anesthesia and to monitor patient during course of anesthesia
HCPCS/CPT Procedure Code definition
All services described by HCPCS/CPT code must be performed
CPT Manual or CMS Manual Coding Instruction
CMS issues coding instructions and guidelines in its manuals, program memoranda and other publications
Mutually Exclusive Procedures
Certain services or procedures would not reasonably be performed at the same session by the same provider on the same beneficiary
Sequential Procedure
Less extensive procedure fails and requires performance of a more extensive procedure
CPT "Separate Procedure" Definition
"Separate procedure" should not be reported when performed along with another procedure in anatomically-related region through same skin incision or surgical approach
More Extensive Procedure
HCPCS/CPT codes corresponding to more extensive procedures always include HCPCS/CPT corresponding to less complex procedures
Female or Male Specific Procedures
Some HCCPS/CPT code descriptors are designated to be reported for male or female
Standards of Medical/Surgical Practice
Many procedures typically necessary to complete more comprehensive procedure are assigned independent HCPCS/CPT codes because they may be performed independently in other settings
Anesthesia Service Included in Surgical Procedure
HCPCS/CPT codes describing anesthesia services or services bundled into anesthesia services should not be reported in addition to surgical procedure requiring the anesthesia service
Laboratory Panel
HCPCS/CPT codes identifying individual tests included in laboratory panels should not be reported separately
Deleted/Modified Edits for NCCI
Based on input from many sources, some edits are deleted
Misuse of Column Two Code with Column One Code
Physician or non-physician provider must perform all services noted in the descriptor unless descriptor states otherwise
Medically Unlikely Edits
Values set based on anatomic considerations, HCPCS/CPT code descriptors, coding instructions, CMS policies, nature of service and clinical judgement

These tables are updated by CMS on a quarterly basis.

Use of an Advance Beneficiary Notice of Noncoverage (ABN) is not appropriate for NCCI situations.

Questions/Concerns

You may submit inquiries about the NCCI program, including those related to NCCI (PTP, MUE, and Add-on Code) edits, in writing via email to NCCIPTPMUE@cms.hhs.gov.

Any submissions made to the NCCI program that contain Personally Identifiable Information (PII) or Protected Health Information (PHI) are automatically discarded, regardless of the content.

Inquiries about a specific claim or how to submit an appeal should be addressed to the Medicare Administrative Contractor (MAC).

Resources

Last Updated Oct 15 , 2025