NCCI Edits
The CMS National Correct Coding Initiative edits that prevent improper payment when incorrect code combinations are reported.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Billing
- Primary sources
- 2
- Workspace handoff
- revenue audit →
Where this comes up
This shows up in revenue-cycle work — claim scrubbing, charge entry, posting, A/R follow-up, and month-end close. Billers and practice managers hit this term when reconciling a payment, working a denial queue, or auditing why a claim aged past 60 days.
Full definition
What it is in practice
The NCCI Procedure-to-Procedure (PTP) edits identify pairs of codes that should not be billed together unless a modifier overrides the edit. The Medically Unlikely Edits (MUE) cap the units of service per beneficiary per day.
How it shows up in your practice
Build NCCI edits into the practice management system pre-claim check. Override only with documented justification using modifier 59 or X{EPSU}.
Sources
- CMS — National Correct Coding Initiativehttps://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits
- CMS — Medically Unlikely Edits (MUE)https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-medically-unlikely-edits
Scan NCCI edits in Revenue Audit
Open revenue audit →Related terms
- BillingMUE (Medically Unlikely Edits)CMS-set maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
- BillingModifier 59CPT modifier identifying a distinct procedural service that is not normally reported together but is appropriate under the circumstances.
- BillingX{EPSU} ModifiersCMS modifiers XE, XS, XP, and XU created to provide a more specific alternative to modifier 59 for indicating distinct procedural services.
- BillingModifier 25CPT modifier indicating that a significant, separately identifiable E/M service was performed by the same provider on the same day as another procedure or service.
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Related across the archive
- GlossaryModifier 59CPT modifier identifying a distinct procedural service that is not normally reported together but is appropriate under the circumstances.
- GlossaryMUE (Medically Unlikely Edits)CMS-set maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.
- GlossaryModifier 25CPT modifier indicating that a significant, separately identifiable E/M service was performed by the same provider on the same day as another procedure or service.
- GlossaryX{EPSU} ModifiersCMS modifiers XE, XS, XP, and XU created to provide a more specific alternative to modifier 59 for indicating distinct procedural services.
- BillingModifier 25: When to Use It and Common MistakesWhen to use modifier -25, when to skip it, and the common mistakes that trigger audits and denials.
- RegulationNCCI Medically Unlikely Edits (MUEs)MUEs are maximum units of service that a single provider would reasonably report on a single date for a single beneficiary, with three adjudication levels (line, date, claim).
- GlossaryPulmonary Function Testing (94010-94799)CPT codes for spirometry, lung volumes, diffusion capacity, and other pulmonary function tests.
- GlossaryCO-97 (Service Included in Another Service)Contractual Obligation 97 — the benefit for this service is included in the payment for another service.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.