National Correct Coding Initiative Edits
Important notice to all NCCI Users concerning the National Correct Coding Initiative Policy Manual for Medicare Services:
The annual updated version of the National Correct Coding Initiative Policy Manual for Medicare Services will be effective January 1, 2013. This manual will be posted on the NCCI website on or around December 1, 2012. Additions and revisions to the manual have been italicized in red font in the electronic copy.
The National Correct Coding Initiative Policy Manual for Medicare Services which was posted December 1, 2012 is PROVISIONAL and modifications may be made to this Manual before the January 1, 2013 version is posted.
The Final National Correct Coding Initiative Policy Manual for Medicare Services has been posted on December 18, 2012. The following pages were changed in this final version which is different from the provisional version posted on December 1, 2012.
- Introduction, Section Purpose, Page – Intro-4
- Chapter I, Section A. Introduction, Page I-7
- Chapter II, Section E. General Policy Statements, #2, Page II-15
- Chapter III, Section L. General Policy Statements, #2, Page III-12
- Chapter IV, Section H. General Policy Statements, #2, Page IV-10
- Chapter V, Section H. General Policy Statements, #2, Page V-22
- Chapter VI, Section H. General Policy Statements, #2, Page VI-12
- Chapter VII, Section I. General Policy Statements, #2, Page VII-13
- Chapter VIII, Section I. General Policy Statements, #2, Page VIII-18
- Chapter IX, Section H. General Policy Statements, #2, Page IX-18
- Chapter X, Section K. General Policy Statements, #2, Page X-19
- Chapter XI, Section W. General Policy Statements, #2, Page XI-39
- Chapter XII, Section E. General Policy Statements, #2, Page XII-12
- Chapter XII, Section C. NCCI Code Specific Issues, #16, Page XII-10
- Chapter XIII, Section E. General Policy Statements, #2, Page XIII-6
To obtain information about Medicaid NCCI methodology edits including the Medicaid NCCI Methodology Complete Edit Files and Change Reports produced by CMS visit the CMS Medicaid NCCI Website:
National Correct Coding Initiative
The CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS developed its coding policies based on coding conventions defined in the American Medical Association's CPT Manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services (Coding Policy Manual). The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool that explains the rationale for NCCI edits.
Carriers implemented NCCI edits within their claim processing systems for dates of service on or after January 1, 1996.
A subset of NCCI edits is incorporated into the outpatient code editor (OCE) for OPPS and therapy providers (Skilled nursing facilities (SNFs), comprehensive outpatient rehabilitation facilities (CORFs), outpatient physical therapy and speech-language pathology providers (OPTs), and home health agencies (HHAs) billing under TOBs 22X, 23X, 75X, 74X, 34X).
The purpose of the NCCI 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.
The Correspondence Language Manual available below has been written and maintained for utilization by the Medicare Contractors to answer routine correspondence inquiries about the NCCI procedure to procedure and MUE edits. The general correspondence language paragraphs explain the rationale for the edits. The section-specific examples add further explanation to the NCCI or MUE edits and are sorted by edit rationale and CPT code section (00000, 10000, 20000, etc.). Please refer to the Introduction of this Manual for additional guidance about its use.
This web page provides information to providers on Medicare's NCCI edits but does not address specific NCCI edits. If the viewer has concerns about specific NCCI edits, he/she may submit comments in writing to:
National Correct Coding Initiative
Correct Coding Solutions LLC
P.O. Box 907
Carmel, IN 46082-0907
Attention: Niles R. Rosen, M.D., Medical Director and Linda S. Dietz, RHIA, CCS, CCS-P, Coding Specialist
Fax #: 317-571-1745
The NCCI Edits Manual may also be obtained by purchasing the manual, or sections of the manual, from the National Technical Information Service (NTIS) website located in the “Related Links Outside CMS” section below, or by contacting NTIS at 1-800-363-2068 or 703-605-6060.
- How to Use The National Correct Coding Initiative (NCCI) Tools [PDF, 2MB]
- R1386CP [PDF, 167KB]
- MM5824 [PDF, 69KB]
- NCCI Policy Manual for Medicare Services - Effective January 1, 2013 [ZIP, 696KB]
- Correspondence Language Manual for Medicare Services - Effective April 1, 2013 [PDF, 208KB]
- Chapter 23 - Fee Schedule Administration and Coding Requirements [PDF, 1MB]
- Modifier 59 Article: Proper Usage Regarding Distinct Procedural Service [PDF, 59KB]
- Page last Modified: 04/17/2013 10:45 AM
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