National Correct Coding Initiative Lookup Tool

The NCCI PTP lookup tool is designed to help providers identify when certain codes are subject to the automated code pair edits.

When two codes of an edit pair are identified, the major/column 1 code is eligible for payment and the minor/column 2 code is denied with CARC C0236. However, both codes may be eligible for payment when the modifier/policy indicator 1 (allowed) is present and an appropriate modifier is appended to the minor/column 2 code on the claim.

Column 1 and Column 2 Codes

• Column 1 Major Code: This is the primary service code that Medicare considers for reimbursement.
• Column 2 Minor Code: This code represents a service that is typically included in the primary service (Column 1) and is generally not separately reimbursed when reported together.

Modifier/Policy Indicator Codes

• Indicator 0: Modifiers are not allowed; codes should not be billed together.
• Indicator 1: An appropriate modifier may be used to override the edit if the clinical scenario justifies it.
• Indicator 9: Not applicable. The code pair is no longer bundled, no modifier is needed for purposes of noting an NCCI exception.

Search for coding pairs by entering a procedure code and the performing date(s) of service. The search results display two coding pair lists; refer to the Major-to-Minor and the Minor-to-Major tabs. See The National Correct Coding Initiative Lookup Tool for more details.