Medicaid NCCI Methodologies

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Medicaid NCCI Methodologies

The Medicaid National Correct Coding Initiative (NCCI) program consists of six methodologies:

1
Procedure-to-Procedure (PTP) edits for practitioner and ambulatory surgical center (ASC) services
2
PTP edits for outpatient services in hospitals (including emergency department, observation, and hospital laboratory services)
3
PTP edits for durable medical equipment
4
Medically Unlikely Edits (MUEs) for practitioner and ASC services
5
MUEs for outpatient services in hospitals
6
MUEs for durable medical equipment

Each of the Medicaid NCCI methodologies has four components:

1
A set of edits
2
Definitions of claim types subject to the edits
3
A set of claim adjudication rules for applying the edits, found in appendices B and C of the Medicaid NCCI Technical Guidance Manual (PDF)
4
Information on claims denials based on the NCCI edits, found in the State Medicaid Director Letter #11-003 (PDF)

The Medicaid NCCI methodologies apply only to Medicaid fee-for-service claims that are reimbursed based on the Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes.

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