The Center for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B claims and Medicaid claims. Visit National Correct Coding Initiative Edits for information about, and edits for, the Medicare NCCI program. The Medicaid NCCI program has significant differences from the Medicare NCCI program.
The Affordable Care Act of 2010 required CMS to notify states by September 1, 2010, of the NCCI methodologies that were compatible with Medicaid. State Medicaid Director Letter (PDF, 133.63 KB) notified states that all five Medicare NCCI methodologies were compatible with Medicaid. The Affordable Care Act required state Medicaid programs to incorporate compatible NCCI methodologies in their systems for processing Medicaid claims by October 1, 2010.
Types of NCCI Edits
The NCCI contains two types of edits:
- NCCI procedure-to-procedure (PTP) edits that define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported.
- Medically Unlikely Edits (MUEs) define for each HCPCS/CPT code the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service.
Revised annual versions of the Medicaid NCCI Policy Manual and the Medicaid NCCI Technical Guidance Manual effective January 1, 2020, are available on the Reference Documents webpage. To assist states that would like to estimate NCCI cost savings, CMS recently developed and posted the NCCI MUE and PTP Edit Savings Guidance for State Medicaid Agencies on the Reference Documents webpage.
Section 6507 of the Affordable Care Act requires states to use “compatible” NCCI methodologies in paying applicable Medicaid claims. If a state determines and documents that there is no other feasible way to comply with Medicaid NCCI edits, the state can send a request to deactivate that edit or those individual edits to the NCCI Contractor using the NCCI mailbox at NCCIPTPMUE@cms.hhs.gov. States are no longer required to send NCCI deactivation requests to CMS Regional Offices.
Please note that CMS no longer participates in the National Medicaid Enterprise Hub (NMEH) calls. However, states can continue to obtain information on the NCCI program using the NCCI Medicaid website and the NCCI Mailbox at NCCIPTPMUE@cms.hhs.gov. As an alternative, states can contact their State Program Integrity Directors for the Fraud Waste and Abuse (FWA) Technical Advisory Group (TAG) calls information. However, only state staff (no contractors) can attend TAG calls.
NCCI Contact Information
This webpage provides information to states, providers, and other interested parties regarding implementation of the NCCI methodologies in the Medicaid program.
Inquiries about the NCCI program, including those related to NCCI (PTP, MUE and Add-On) edits, should be sent to NCCIPTPMUE@cms.hhs.gov.
If the viewer has concerns about specific NCCI edits, they may submit comments in writing to:
National Correct Coding Initiative Contractor
P.O. Box 368
Pittsboro, IN 46167