Medicaid NCCI Edit Files

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Medicaid NCCI Edit Files

CMS posts the complete updated Medicaid National Correct Coding Initiative (NCCI) edit files for the public on this page at the beginning of each calendar quarter. These replace the Medicaid NCCI edit files from previous calendar quarters.

The presence of an HCPCS/CPT code in a Procedure-to-Procedure (PTP) edit - or a Medically Unlikely Edits (MUEs) value for an HCPCS/CPT code - doesn’t necessarily indicate that the code is covered by any or all state Medicaid programs.

Note: States cannot use the files posted here for processing and paying Medicaid claims. States must download the NCCI edit files available on the Regional Information Sharing System portal (RISSNET) and must ensure that they or their vendor uses the appropriate Medicaid NCCI edits to adjudicate Medicaid claims.

How to Access the Files

This page provides links to NCCI Edit files. To download each edit file, just select the link listed below. After you select the desired link, the zip file should download. Each zip file contains both text and Excel file(s) formats.

Note: Excel limits the number of rows that can be exported in a single file to 1,048,576 rows. The Practitioner and Outpatient Hospital PTP edit files both contain significantly more rows than that.

To download the complete edit file, save the zip file to your computer and extract the text and Excel file(s).

Related Downloads

Page Last Modified:
12/01/2023 03:42 PM