National Correct Coding Initiative
The Medicare NCCI promotes correct coding of Medicare Part B claims. Coding policies are based on coding conventions defined in the AMA’s CPT professional, national and local Medicare policies and edits, coding guidelines developed by national societies, standard medical and surgical practices, and a review of current coding practices.
Before implementing NCCI edits, CMS shares all NCCI proposed edits for review and comment with the AMA, national medical and surgical societies, and other national health care organizations, including nonphysician professional societies, hospital organizations, laboratory organizations, and DME organizations.
There are three types of NCCI edits:
- PTP Edits
- Define pairs of HCPCS and CPT codes that providers shouldn't report together for various reasons. PTP edits prevent improper payments when you report incorrect code combinations. Each edit has a Column 1 and a Column 2 HCPCS/CPT code.
- Mutually Exclusive Edits
- Identify code pairs that Medicare has determined, for clinical reasons, are unlikely to be performed on the same patient on the same day. For example, a mutually exclusive edit might identify two different types of testing that yield equivalent results. When two mutually exclusive services are submitted on a claim, only the service of lesser value will be reimbursed.
- Add-on Codes
- HCPCS/CPT code that describes a service that is performed in conjunction with the primary service by the same practitioner. An AOC is rarely eligible for payment if it’s the only procedure reported by a practitioner.
If you have concerns regarding specific NCCI edits, please submit your comments in writing to NCCIPTPMUE@cms.hhs.gov.
Posted 3/3/2025