NCCI Chapter 11: Evaluation and Management Services
NCCI policy on bundling and separately reporting E/M services with procedures, including modifier 25 use and global surgical package interactions.
Primary source
NCCI Policy Manual Chapter 11 (Medicine) — CMS.gov →https://www.cms.gov/medicare/coding-billing/national-correct-coding-initiative-ncci-edits/medicare-ncci-policy-manual
Verified May 23, 2026 · This is the authoritative regulator URL. The summary below is a research aid; the linked source controls.
NCCI Chapter 11 of the NCCI Policy Manual addresses E/M service coding, including the bundling rules for E/M services performed on the same date as procedures or other services.
Core principles:
- A minor surgical procedure includes the pre-procedure evaluation; a separate E/M is generally not reportable unless the E/M is significant and separately identifiable, in which case modifier 25 may be applied.
- A major surgical procedure (90-day global) includes the decision-for-surgery E/M only when furnished on the day of or day before surgery. The first E/M leading to the surgery may be reported with modifier 57.
- Global surgical package E/Ms during the post-op period are generally bundled; modifier 24 reports unrelated E/Ms.
- E/M services billed with diagnostic procedures follow the same significant-and-separately-identifiable analysis.
NCCI PTP edits enforce these rules at the claim level. The substantive policy in Chapter 11 is the documentation framework. The 2021 CPT E/M revisions (history/exam not used for selection; MDM or time controls) did not change NCCI bundling logic — they changed how the E/M itself is scored, not whether it can be reported.
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Related across the archive
- RegulationModifier 25: Significant, Separately Identifiable E/M ServiceModifier 25 is appended to an E/M code when the E/M is significant and separately identifiable from another procedure or service performed on the same day by the same provider.
- RegulationNCCI Policy Manual OverviewThe National Correct Coding Initiative is the CMS coding edits program that prevents improper Medicare payment due to incorrect code reporting; the Policy Manual is the authoritative coding-policy reference.
- RegulationNCCI Modifier Overrides (Modifier 59 and X{EPSU})Modifier 59 (and its more specific subsets XE, XS, XP, XU) is the principal mechanism for overriding a PTP edit when a procedure is distinct or independent from another performed on the same day.
- RegulationNCCI Global Surgical Package PolicyMedicare's global surgical package bundles preoperative, intraoperative, and routine postoperative care into a single payment for the surgical CPT code, with global periods of 0, 10, or 90 days.
- RegulationNCCI Chapter 10: Pathology and Laboratory PoliciesNCCI policies for clinical laboratory services, including panel-vs-component coding, automated multi-channel chemistry rules, and Date of Service rules for lab tests.
- RegulationNCCI Chapter 9: Radiology PoliciesNCCI policies specific to radiology services, including component coding rules (technical and professional), supervision and interpretation services, and contrast/non-contrast bundling.
- RegulationNCCI Bilateral Procedure Reporting RulesMedicare's policy for reporting bilateral procedures uses the MPFS Bilateral Indicator (0, 1, 2, 3, 9) and depends on whether the code descriptor already includes both sides.
- 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).
Last reviewed May 23, 2026 · Citation verified May 23, 2026
Research aid, not legal advice. This summary is an administrative research aid prepared by D3rx. It does not certify compliance, provide legal advice, replace counsel, or guarantee an audit outcome. For authoritative regulatory text follow the primary source link at the top of this page. The practice remains responsible for reviewing, adopting, and maintaining its compliance program.