Medicaid NCCI Edit Files

Complete Medicaid NCCI Edit Files for Calendar Quarter Beginning July 1, 2022

silhouette icon of two adults with child

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, where you can filter, sort, share, and download the files. To download data as an Excel file, follow the links on the left to navigate to your desired dataset. Note: Excel limits the number of rows that can be exported in a single CSV for Excel 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 as a CSV/TEXT file, click the file name from the list of files. From the new page, then select the Download filtered view (CSV) link under the Access heading. The browser will download the selected file. Once the downloading progress stops, drag the file into the desired folder. Right-click on the downloaded CSV file, select “Open with,” and click on the “Notepad”.

Complete Medicaid NCCI Edit Files for Calendar Quarter Beginning Oct. 1, 2022

Page Last Modified:
09/08/2022 11:10 AM