NCCI Policy Manual Overview
The 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.
Primary source
NCCI Policy Manual for Medicare Services — 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.
Additional sources
The NCCI Policy Manual is the authoritative coding-policy reference for the CMS National Correct Coding Initiative. It is updated annually each January.
NCCI has three components: Procedure-to-Procedure (PTP) edits, Medically Unlikely Edits (MUEs), and Add-on Code edits. The Policy Manual organizes guidance by chapter — General Correct Coding Policies (Chapter 1) plus 12 chapters keyed to CPT/HCPCS code categories (anesthesia; surgery sections by body system; radiology; pathology and lab; medicine; HCPCS).
The Manual binds Medicare contractors and is widely adopted by state Medicaid programs and commercial payers. NCCI PTP and MUE edit files are published quarterly and applied to claims at the MAC level. NCCI is not optional reading; correct CPT and HCPCS coding for Medicare requires familiarity with the relevant Policy Manual chapter.
Practical use: when a claim is denied with reason code referring to NCCI edits, the Policy Manual chapter for the procedure category explains the underlying policy rationale and the rules for modifier overrides where permitted. Quarterly NCCI updates can introduce new edits with material payment impact.
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Related regulations
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Related across the archive
- 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 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).
- RegulationNCCI Procedure-to-Procedure (PTP) EditsPTP edits identify code pairs that should not be reported together because one is a component of the other or because reporting both is otherwise inconsistent with correct coding.
- 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.
- 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 Chapter 11: Evaluation and Management ServicesNCCI policy on bundling and separately reporting E/M services with procedures, including modifier 25 use and global surgical package interactions.
- 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.
- GlossaryCO-97 (Service Included in Another Service)Contractual Obligation 97 — the benefit for this service is included in the payment for another service.
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.