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NCCI Procedure to Procedure Lookup

Physicians & practitioners: Use the Part B NCCI Procedure to Procedure Lookup.

National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) edits prevent improper payment for incorrect coding combinations (i.e., services that shouldn’t be reported together). CMS assigns PTP edits to code pairs (Column 1 & Column 2 HCPCS/CPT codes) when:

  • One code (Column 2) is a component of a more comprehensive code (Column 1).
  • The 2 codes are mutually exclusive.

If you report both codes of an edit pair for the same beneficiary on the same date of service:

  • The Column 1 code is eligible for payment.
  • The Column 2 code will deny unless you also report a clinically appropriate modifier.

Use this tool to prevent or resolve NCCI PTP claim denials:

  • Enter a procedure code.
  • A list of PTP edit code pairs will display (if applicable for the procedure code entered).
  • The Modifier Indicator assigned to the code pair identifies whether it’s appropriate to report a modifier to receive payment for both codes:

Modifier Indicator

Explanation

0
(Not allowed)

No NCCI-associated modifier (59, XE, XP, XS or XU) is allowed to bypass the edit. Medicare will only pay for the Column 1 code for the same patient on the same day.

Note: Since NCCI edits are coding denials, not medical necessity denials, it’s not appropriate to issue an Advance Beneficiary Notice of Noncoverage (ABN) to shift liability to the patient.

1
(Allowed)

You may report an NCCI-associated modifier (59, XE, XP, XS or XU) to allow payment for both codes when appropriate.

Note: Make sure the patient’s medical record includes documentation to support that both codes are clinically appropriate.

9
(Not applicable)

The edit for the code pair isn’t active since the deletion date is the same as the effective date.

Procedure Code:     

Resources

Updated: 10.21.2025

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