MACs implement NCCI PTP edits within their claim processing systems, and CMS incorporates PTP edits into the outpatient code editor (OCE) for the Outpatient Prospective Payment System (OPPS). Refer to the How to Use NCCI Tools booklet (PDF) for more information. The purpose of the NCCI Medically Unlikely Edits (MUE) program is to prevent improper payments when services are reported with incorrect units of service. The NCCI contains one table of edits for physicians or practitioners and one table of edits for outpatient hospital services.

The purpose of the NCCI Procedure to Procedure (PTP) edits is to prevent improper payment when incorrect code combinations are reported. CMS owns the NCCI program and is responsible for all decisions regarding its contents.ĬMS develops its coding policies based on coding conventions defined in the American Medical Association’s Current Procedural Terminology (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. Please refer to the Introduction of the manual for additional guidance about its use.ĬMS developed the NCCI program to promote national correct coding of Medicare Part B claims.

The section-specific examples further explain the PTP or MUE edits and are sorted by edit rationale and CPT code section (00000, 10000, 20000, etc.). The general correspondence language paragraphs explain the rationale for the edits. CMS wrote the manual and maintains it for use by the MACs to answer routine correspondence inquiries about the NCCI PTP and MUE edits.

The most recent Medicare NCCI Correspondence Language Manual annual revision was posted on March 9, 2022.

Additional prior versions of the National Correct Coding Initiative Policy Manual for Medicare Services are available in the NCCI Policy Manual Archive. Additions and revisions to the manual are noted in red font. The most current policy manual, effective Jan. The NCCI Policy Manual should be used by Medicare Administrative Contractors (MACs) as a general reference tool that explains the rationale for NCCI edits.

CMS updates the NCCI Policy Manual for Medicare once a year.

New mac release 2018