All rights reserved. The MUE files on the NCCI website display "MUE Adjudication Indicators" (MAIs) for each HCPCS/CPT code. You can decide how often to receive updates. The CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL CONTAINED ON THIS PAGE. if(pathArray[4]){document.getElementById("usprov").href="/web/"+pathArray[4]+"/help/us-government-rights";} Effective Jan. 1, 2022, CMS implemented one new format for who Add-on Code (AOC) correct file. Reproduced with permission. The AMA warrants that due to the nature of CPT, it does not manipulate or process dates, therefore there is no Year 2000 issue with CPT. But, if both codes are clinically appropriate and you use an appropriate NCCI-associated modifier, the codes in both columns are eligible for payment. Medicare NCCI Procedure to Procedure (PTP) Edits To obtain comprehensive knowledge about the UB-04 codes, the Official UB-04 Data Specification Manual is available for purchase on the American Hospital Association Online Store. Hospital PTP code pair tables work the same as the practitioner PTP code pair tables, Modifiers and coding pairs may differ from the practitioner PTP code pair tables because of differences between facility and professional services. Type II - A Type II add-on code does not have a specific list of primary procedure codes. Washington, D.C. 20201 The subregulatory guidance includes clear correct coding policy that is binding on both providers and CMS claims processing contractors. They started with the add on code edits, January 1, 2013. If you filter Microsoft Excel for 99215 in Column 2 of the Practitioner PTP Edits Table containing edits from 0001A/0591T1-25999/96523 (or similar range), youll see that 99215 isnt payable with 01462, Anesthesia for all closed procedures on lower leg, ankle, and foot. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS). CMS will update the complete list of AOC edits on an annual basis on or by Jan. 1 based on changes to theCPT Manual or HCPCS Level II Manual. Microsoft Excel - Work together on Excel spreadsheets - Office The Change Request (CR) lists the Type 1 AOCs with their acceptable primary procedure codes. This includes items such as CPT codes, CDT codes, ICD-10 and other UB-04 codes. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Effective Jan. 1, 2022, CMS implemented a new format for the Add-on Code edit file. An official website of the United States government. However, because NCCI edits are implemented by the MACs as part of routine claim processing, claim-specific inquiries must be made to the MAC. To report a separate and distinct E/M service with a non-E/M service performed on the same date, modifier 25 is used. CMS has not created MUEs for all HCPCS/CPT codes. In the Correct Coding Modifier Indicators (CCMIs) column, the indicator 0, 1, or 9 shows whether an NCCI PTP-associated modifier allows the PTP code pair to bypass the edit. ) MAIs of 3' are per day edits based on clinical benchmarks. CMS made the decision to retain the edits that were in effect prior to January 1, 2020, and to delete January 1, 2020, PTP edits for Current Procedural Terminology (CPT) code pairs 97530 or 97150/97161, 97530 or 97150/97162, 97530 or 97150/97163, 97530 or 97150/97165, 97530 or 97150/97166, 97530 or 97150/97167, 97530 or 97150/97169, 97530 or 97150/97170, 97530 or 97150/97171, and 97530 or 97150/97172. On the Medicare Physician Fee Schedule Database, an AOC generally has a global surgery period of ZZZ., In theCPT Manualan add-on code is designated by the symbol +. The code descriptor of an AOC generally includes phrases such as each additional or (List separately in addition to primary procedure)., An official website of the United States government, National Correct Coding Initiative (NCCI), Add-On Code Edits Implementation for Medicare Effective 07012023 (ZIP), Add-On Code Edits Implementation for Medicare Effective 01012023 (ZIP), Help with File Formats Figure 10 shows the filter options that appear on the right side of the page when you choose the Filter data button on the Dataset page. CMS developed the coding policies based on coding principals defined in the American Medical Association's (AMA's) CPT Manual, through national and local policies and edits, and through coding guidelines developed by: These edits are prepay edits that are applied automatically to claims based on the specific coding listed on the claim. CMS Disclaimer Each zip file contains both text and Excel file(s) formats. Note: Excel limits the number of rows that can be exported in a single CSV for Excel file to 1,048,576 rows. For example, code 99215 can appear in Column 2 of Practitioner PTP Edits tables. The NCCI contractor cannot process specific claim appeals, and cannot forward appeal submissions to the appropriate appeals contractor. No fee schedules, basic unit, relative values or related listings are included in CDT. You can filter by: To add more filter parameters, click the Add another filter link as shown in Figure 11. The different types of NCCI edits Outpatient rehab therapists should be aware of the various types of NCCI edits. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, National Correct Coding Initiative (NCCI), Introduction for National Correct Coding Initiative Policy Manual for Medicare Services (PDF), Chapter 1 - General Correct Coding Policies (PDF), Chapter 2 - Anesthesia Services Current Procedural Terminology CPT Codes 00000-01999 (PDF), Chapter 3 - Surgery: Integumentary System CPT Codes 10000-19999 (PDF), Chapter 4 - Surgery: Musculoskeletal System CPT Codes 20000-29999 (PDF), Chapter 5 - Surgery: Respiratory, Cardiovascular, Hemic and Lymphatic Systems CPT Codes 30000-39999 (PDF), Chapter 6 - Surgery: Digestive System CPT Codes 40000-49999 (PDF), Chapter 7 - Surgery: Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems CPT Codes 50000-59999 (PDF), Chapter 8 - Surgery: Endocrine, Nervous, Eye and Ocular Adnexa, and Auditory Systems CPT Codes 60000-69999 (PDF), Chapter 9 - Radiology Services CPT Codes 70000-79999 (PDF), Chapter 10 - Pathology/Laboratory Services CPT Codes 80000-89999 (PDF), Chapter 11 - Medicine, Evaluation and Management Services CPT Codes 90000-99999 (PDF), Chapter 12 - Supplemental Services HCPCS Level II Codes A0000-V9999 (PDF), Chapter 13 - Category III Codes CPT Codes 0001T-0999T (PDF), Help with File Formats Official websites use .govA NCCI for Medicare | CMS - Medicaid NCCI Edit Files | CMS Please make the 2023 Q1 Edits Files until CMS posts the 2023 Q3 Edit Files. When youre done looking at the records filtered by the code you want, select on the filter symbol in the column you filtered, and select Clear Filter from Column 2 as shown in Figure 6. Each edit has a column one and column two HCPCS/CPT code. Share sensitive information only on official, secure websites. **NOTE** Any submissions made to the NCCI contractor that contain Personally Identifiable Information (PII) or Protected Health Information (PHI) are automatically discarded, regardless of the content, in accordance with federal privacy rules with which the NCCI Contractor must comply. To download each edit file, just select the link listed below. Use the Microsoft Excel filter tool so all instances of a particular code are displayed in Column 2. The second condition says: Modifier Indicator is 1. To download the complete edit file, save the zip file to your computer and extract the text and Excel file(s). Note: Excel limits the number of rows that can be exported in a single CSV for Excel file to 1,048,576 rows. States must download the NCCI edit files available on the Regional Information Sharing System portal (RISSNET) and must ensure that they or their vendor uses the appropriate Medicaid NCCI edits to adjudicate Medicaid claims. website belongs to an official government organization in the United States. NCCI Edits | AOTA There is no active edit for this PTP code pair. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, National Correct Coding Initiative (NCCI), Regional Information Sharing System portal (RISSNET), 2023 Q3NCCI PTP Edits - Practitioner Services, 2023 Q3NCCI PTP Edits - Outpatient Hospital Services, 2023 Q3NCCI PTP Edits - Durable Medical Equipment Services, 2023 Q3NCCI MUE Edits - Practitioner Services, 2023 Q3NCCI MUE Edits - Outpatient Hospital Services, 2023 Q3NCCI MUE Edits - Durable Medical Equipment Services, Help with File Formats If this is a U.S. Government information system, CMS maintains ownership and responsibility for its computer systems. or AMA Disclaimer of Warranties and Liabilities You may also contact AHA at ub04@healthforum.com. (These are released as gigantic Excel spreadsheets). Sign up to get the latest information about your choice of CMS topics. Before NCCI implements new or changes an existing MUEs, NCCI submits the proposed edits for review and comments to the: MUEs are developed based on the reasonable practice for procedures and coding guidelines. You can decide how often to receive updates. The scope of this license is determined by the AMA, the copyright holder. CMS also takes into consideration anatomic probabilities, medical policies, clinical judgments and finally the framework or the nature of the service/procedure. ; Medicare: The most recent edit files, including quarterly version update changes, are available on the PTP Coding Edits page, the Medically Unlikely Edits page, and the Add-On Code Edits page. The Centers for Medicare & Medicaid Services (CMS) owns the NCCI program and is responsible for all decisions regarding its contents. CMS Reverses Position, Will Reinstitute Damaging Coding Edits Oct. 1 You can remove the Filter by choosing Data and Filter, and selecting "Clear Filter". Applications are available at the American Dental Association web site, http://www.ADA.org. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. Any submissions made to the NCCI program that contain Personally Identifiable Information (PII) or Protected Health Information (PHI) are automatically discarded, regardless of the content. The Column 1/Column 2 Correct Coding edit tables contain PTP code pairs. Please upgrade lock (Announcement posted October 1, 2021), Replacement Files (1st quarter of 2021) - CMS issued replacement files for NCCI Medically Unlikely Edits (MUEs) for the January 1, 2021 files. Using the NCCI Policy Manual for Medicare, Quarterly PTP and MUE Version Update Changes. lock To sign up for updates or to access your subscriber preferences, please enter your contact information below. Column F shows if you can use a modifier. Updated public replacement files for Medicare areavailable using the links in the left navigation pane. Choose the Column 2 heading and then choose Data and Filter. Each version ends with a .0 (point zero), a .1 (point one), a .2 (point two), or a .3 (point three). It is used for payment of medical services required to treat work related injuries and illnesses. lock The MUE tables are in compressed zipped files. However, claims processing contractors are advised that these lists are not exclusive and there are other acceptable primary procedure codes for AOCs in this Type. Because Excel 2007 can support a larger number of rows, each code range is contained in one file as opposed to . Figure 2 shows part of the Practitioner PTP Edits Table containing edits from 61000/0213T-U0003/U0004 (or similar range), with our example code 99215 in Column 1. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Complete the assessment quiz contained in this resource book. If you scroll to the bottom of the PTP Coding Edits page and click on Help with File Formats and Plug-Ins, you can download free software. The ADA is a third-party beneficiary to this Agreement. All material posted on our website is . Official Medical Fee Schedule (OMFS) The Official Medical Fee Schedule (OMFS) is promulgated by the DWC administrative director under Labor Code section 5307.1 and can be found in sections 9789.10 et seq. Each edit has a Column One and Column Two HCPCS/CPT code. The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. 2. ), Filter value (This depends on the column name and verb content you choose. Access to this feature is available in the following products: NCCI Edits & Validator Find-A-Code Professional Find-A-Code Facility Base DISCLAIMER: Our edits are taken directly from published government sources. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. You may submit inquiries about the NCCI program, including those related to NCCI (PTP, MUE, and Add-on Code) edits, in writing via email to NCCIPTPMUE@cms.hhs.gov. You shall not remove, alter, or obscure any ADA copyright notices or other proprietary rights notices included in the materials. Many times the code pair edit simply represents two codes that should not be reported together. The browser will start working to download the file. You may also contact AHA at ub04@healthforum.com. .gov This shows the function of the Add Filters column with two conditions applied. 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. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. 1. This figure shows the options that appear at the top of the Add Filters column. Therefore, you have no reasonable expectation of privacy. The ADA does not directly or indirectly practice medicine or dispense dental services. PDF How to use the Medicare National Correct Coding Initiative (NCCI) Tools Applications are available at the AMA Web site, https://www.ama-assn.org. National Council on Compensation Insurance (NCCI) Announcements Medicare NCCI Medically Unlikely Edits (MUEs) National Correct Coding Initiative (NCCI) Medically Unlikely Edits (MUEs) are used by the Medicare Administrative Contractors (MACs), to reduce improper payments for Part B claims. When no modifiers are allowed, only the Column 1 code will be paid for the same patient on the same day. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS). var pathArray = url.split( '/' ); The purpose of the NCCI MUE program is to prevent improper payments when services are reported with incorrect units of service. An MUE for a HCPCS/CPT code is the maximum UOS you would report under most circumstances for a single patient on a single date of service.