NCCI Edits Validator™ Medicaid Edition 2024

CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding and to control improper coding that leads to inappropriate payments for Part B claims. The Centers for Medicare & Medicaid Services (CMS) owns the NCCI program and is responsible for all decisions regarding its contents. 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. CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicaid Services (Coding Policy Manual). The Coding Policy Manual should be utilized by carriers and FIs (Fiscal Intermediary) as a general reference tool that explains the rationale for NCCI edits.

The purpose of the NCCI Procedure-to-Procedure (PTP) 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 PTP code pairs that should not be reported together for a number of reasons explained in the Coding Policy Manual. The purpose of the NCCI MUE program is to prevent improper payments when services are reported with incorrect units of service.

Find-A-Code's NCCI Edits Validator tool compares CPT/HCPCS using the NCCI PTP Edits. To use this calculator...