Not Separately Payable/National Correct Coding Initiative

CARC/RARC DESCRIPTION
CO-236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.

 

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
  • 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

 

Last Updated Mon, 12 Jul 2021 15:16:38 +0000