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Medicaid NCCI Edit Files

The complete updated Medicaid National Correct Coding Initiative (NCCI) edit files are posted here at the beginning of each calendar quarter. These data replace the Medicaid NCCI edit files from previous calendar quarters. The presence of a HCPCS/CPT code in a Procedure-to-Procedure (PTP) edit or a Medically Unlikely Edits (MUEs) value for a HCPCS/CPT code does not necessarily indicate that the code is covered by any state Medicaid program or by all state Medicaid programs. States cannot use the files here for processing and paying Medicaid claims.

How to Access the Files

This page provides links to NCCI Edit data on Data.Medicaid.gov, where you can filter, sort, share, and download the data. To download data as an Excel file, first follow the links on this page to navigate to your dataset. Select the “Export” button in the top right of the data, then select “CSV for Excel” from the download list.

Note: Excel limits the number of rows that can be exported in a single CSV for Excel file to 1,048,576 rows. The Practitioner and Outpatient Hospital PTP edit files both contain significantly more rows than that. To download the complete Practitioner or Outpatient Hospital PTP edit file, we recommend using the Filter function to divide the complete file into two smaller files:

  1. Effective date between October 1, 2010 and March 31, 2013
  2. Effective date after March 31, 2013

Each file can then be exported in CSV for Excel. The Durable Medical Equipment PTP edit file and all three MUE files can be exported as single CSV for Excel files.

Complete Medicaid NCCI Edit Files for Calendar Quarter Beginning July 1, 2021

Complete Medicaid NCCI Edit Files for Calendar Quarter Beginning April 1, 2021

Medicaid Change Report Files

The Medicaid Change Report files contain only the changes made in the Medicaid NCCI edit files from the previous calendar quarter. Information on these files is contained in Change Report File Information (DOCX, 14.62 KB).