Medicare NCCI Procedure to Procedure (PTP) Edits
National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits prevent inappropriate payment of services that should not be reported together. Each edit has a Column One and Column Two HCPCS/CPT code. If a provider reports the two codes of an edit pair for the same beneficiary on the same date of service, the Column One code is eligible for payment, but the Column Two code is denied unless a clinically appropriate NCCI PTP-associated modifier is also reported.
Quarterly Version Update Changes
CMS posts changes to each of its NCCI PTP published edit files on a quarterly basis. This includes additions, deletions, and modifier indicator quarterly changes to PTP column one/column two correct coding edits and the PTP mutually exclusive code edits for Practitioners and Hospital Outpatient PPS in the Outpatient Code Editor.
Related Downloads
2023 Quarter 4 Edit Files:
Hospital PTP Edits
- Hospital PTP Edits v293r1 (621,148 Records) 0001A/0591T – 27894/G0471 (ZIP) - Effective Oct. 01, 2023; Posted Sep. 14, 2023
- Hospital PTP Edits v293r1 (535,728 Records) 28001/0213T – 49999/49570 (ZIP) - Effective Oct. 1, 2023; Posted Sep. 14, 2023
- Hospital PTP Edits v293r1 (396,073 Records) 50010/0213T – 79999/36000 (ZIP) - Effective Oct. 1, 2023; Posted Sep. 14, 2023
- Hospital PTP Edits v293r1 (219,071 Records) 80003/80002 – U0003/U0004 (ZIP) - Effective Oct. 1, 2023; Posted Sep. 14, 2023
Practitioner PTP Edits
- Practitioner PTP Edits v293r1 (662,411 Records) 0001A/0591T – 25999/96523 (ZIP) - Effective Oct. 1, 2023; Posted Sep. 14, 2023
- Practitioner PTP Edits v293r1 (614,258 Records) 26010/01810 – 36909/J2001 (ZIP) - Effective Oct. 1, 2023; Posted Sep. 14, 2023
- Practitioner PTP Edits v293r1 (595,709 Records) 37140/0213T – 60699/96523 (ZIP) - Effective Oct. 1, 2023; Posted Sep. 14, 2023
- Practitioner PTP Edits v293r1 (669,619 Records) 61000/0213T – U0003/U0004 (ZIP) - Effective Oct. 1, 2023; Posted Sep. 14, 2023
2023 Quarter 3 Edit Files:
Hospital PTP Edits
- Hospital PTP Edits v292r0 (621,148 Records) 0001A/0591T – 27894/G0471 (ZIP) - Effective Jul. 1, 2023; Posted Sep. 28, 2023
- Hospital PTP Edits v292r0 (535,728 Records) 28001/0213T – 49999/49570 (ZIP) - Effective Jul. 1, 2023; Posted Sep. 28, 2023
- Hospital PTP Edits v292r0 (396,073 Records) 50010/0213T – 79999/36000 (ZIP) - Effective Jul. 1, 2023; Posted Sep. 28, 2023
- Hospital PTP Edits v292r0 (219,071 Records) 80003/80002 – U0003/U0004 (ZIP) - Effective Jul. 1, 2023; Posted Sep. 28, 2023
Practitioner PTP Edits
- Practitioner PTP Edits v292r0 (662,411 Records) 0001A/0591T – 25999/96523 (ZIP) - Effective Jul. 1, 2023; Posted Sep. 28, 2023
- Practitioner PTP Edits v292r0 (614,258 Records) 26010/01810 – 37140/0213T (ZIP) - Effective Jul. 1, 2023; Posted Sep. 28, 2023
- Practitioner PTP Edits v292r0 (595,707 Records) 37140/0213T – 61000/0213T (ZIP) - Effective Jul. 1, 2023; Posted Sep. 28, 2023
- Practitioner PTP Edits v292r0 (669,602 Records) 61000/0216T – U0003/U0004 (ZIP) - Effective Jul. 1, 2023; Posted Sep. 28, 2023
