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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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  • National Correct Coding Initiative

National Correct Coding Initiative 

Welcome to our NCCI page.  The Centers for Medicare and Medicaid Services developed the National Correct Coding Initiative to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Part B claims.  The PTP Edits are a list of code pairs that cannot be billed together (Modifier 59 can be used in certain circumstances).  MUE Edits are the maximum number of service units that can be billed in a day.  Add-on code edits consist of a listing of HCPCS and CPT add-on codes with their respective primary codes. An add-on code is eligible for payment only if one of its primary codes is also eligible for payment.

Updated to the July 2021 changes.

Procedure to Procedure (PTP) Edits 

  • PTP Basics
  • Using Modifier 59 and X~ Modifiers
  • PTP Hospital Edits
  • PTP Practitioner Edits 

Medically Unlikely Edits (MUE)

  • Guide to Using Medically Unlikely Edits
  • July 1, 2021 Therapy Edits
  • April 1, 2021 Therapy Edits
  • January 1, 2021 Therapy Edits

Add-on Code Edits

    • Biofeedback
    • Cognitive intervention
    • Work Hardening
    • Wound Debridement 

Policy for Physical Medicine and Rehabilitation - January 1, 2021 

  • Multiple Evaluations on the Same Day
  • Evaluations and other Assessment Codes
  • Billing more than one Service in a 15 Minute Period
  • Re-evaluations
  • Re-evaluation and Orthotic/Prosthetic Management
  • Assistive Technology Assessment
  • Manual Therapy Techniques and Therapeutic Activities (Removed Jan. 1, 2021)
  • Wound Debridement and Surgical Debridement
  • Cardiac Rehabilitation and other Therapy Services
  • Ultrasound and Wound Care

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