The Centers for Medicare and Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to eliminate improper coding. The Affordable Care Act of 2010 required state Medicaid programs to incorporate compatible NCCI methodologies in their systems for processing Medicaid claims.
NCCI associated modifiers may be appended when and only when appropriate clinical circumstances are documented in accordance with the NCCI policies and the HCPCS/CPT Manual instructions/definitions for the modifier/procedure code combination.
NCCI edits are applied to the following:
- Practitioners and ambulatory surgical centers (ASC) services.
- Hospital Outpatient Services.
- Durable Medical Equipment.
There are 2 types of NCCI edits:
- Procedure to Procedure (PTP) edits are define as code pairs that should not be reported together for a beneficiary on the same date of service.
- Medically Unlikely Edits (MUEs) define the maximum units of service (UOS) that a provider would bill for a beneficiary on a single date of service.
Providers are encouraged to monitor CMS website for quarterly edit file updates. Find more information about the CMS Medicaid National Correct Coding Initiative, please visit the following:
For instructions on how to fine NCCI MUEs, providers can click on the resource below (click the link or the image):
