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NCCI edits reference: the Medicare correct coding tables in one place

The National Correct Coding Initiative is the set of automated edits Medicare runs on Part B claims to stop payment for code combinations and unit counts that correct coding does not support. It has three parts: procedure-to-procedure (PTP) pairs, Medically Unlikely Edits (MUEs) and add-on code edits. In the 2026 Q4 release the practitioner PTP table holds 1,732,820 active pairs and the hospital outpatient table 1,406,699; MUEs are published for 15,212 codes on practitioner claims; and 723 add-on codes carry 7,743 add-on edits. This hub explains each part with figures computed from the CMS files and links to the tools and guides that answer a specific question.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI add-on code edits: 2026 Q4 (effective October 1, 2026); I/OCE data tables (edits, status and payment indicators): I/OCE v27.3 (October 2026) (effective October 1, 2026); Medicare NCCI Policy Manual: 2026 edition (effective January 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the NCCI PTP edits and NCCI MUE tables and NCCI add-on code edits; January 1, 2027 (quarterly I/OCE release) for the I/OCE data tables (edits, status and payment indicators); the 2027 edition, effective January 1, 2027 for the Medicare NCCI Policy Manual.

Practitioner PTP pairs
1,732,820
10,881 column-1 codes, v323r0 (2026 Q4)
Hospital outpatient PTP pairs
1,406,699
10,011 column-1 codes
Practitioner pairs that allow a modifier
70%
hospital outpatient: 96%
Codes with a practitioner MUE
15,212
outpatient hospital 15,162, DME 3,109
Add-on codes
723
7,743 active add-on edits
I/OCE v27.3 edits in effect
111
of 145 edit numbers in the table

The three NCCI edit types

Each edit type answers a different question about a claim. The sizes below are counted from the 2026 Q4 CMS files, active rows only.

NCCI edit types and their size in the 2026 Q4 release
Edit typeWhat it stopsSize, 2026 Q4Look it up
Procedure-to-procedure (PTP)Two codes reported together for one patient on one date when one is part of, or cannot be done with, the other1,732,820 practitioner pairsCheck a code pair
Medically Unlikely Edit (MUE)More units of one code on one date than almost any correctly coded claim would carry15,212 practitioner codesLook up a unit limit
Add-on code editAn add-on code billed without an accepted primary procedure on the claim7,743 editsBrowse the add-on codes

A PTP edit names a column-one code, which is paid, and a column-two code, which is denied when both are reported for the same beneficiary by the same provider on the same date of service, unless the edit allows a modifier and the record supports a distinct service. An MUE is the maximum number of units CMS expects for one code on one date; units above it deny, and the adjudication indicator decides whether the limit is tested line by line or across the whole date. An add-on code edit pairs each add-on code with the primary codes it may be reported with. The three run independently, so a claim can pass the pair check and still deny for units or for a missing primary.

Why pairs are bundled: the edit rationales

Every PTP pair carries one of 12 rationale labels that name the coding principle behind it. Three account for most of the practitioner table: "Misuse of Column Two code with Column One code" (40%), "Standards of medical/surgical practice" (26%) and "CPT Manual or CMS manual coding instruction" (25%). The misuse rationale covers pairs that CMS manuals and coding instructions say should not be reported together, often for reasons the code descriptors themselves do not state; the standards-of-practice rationale covers services that are a normal part of performing the column-one procedure, such as venous access or monitoring. The policy manual's first chapter defines each rationale, and the chapter guide summarizes it.

Active PTP pairs by edit rationale, v323r0 (2026 Q4)
CMS rationalePractitioner pairsShareHospital outpatient pairs
Misuse of Column Two code with Column One code685,69740%682,144
Standards of medical/surgical practice446,85126%441,430
CPT Manual or CMS manual coding instruction441,09325%134,467
Standard preparation/monitoring services for anesthesia71,1414%68,168
HCPCS/CPT procedure code definition24,4851%24,299
Mutually exclusive procedures20,5031%19,979
CPT Separate procedure definition16,1201%16,124
More extensive procedure15,4411%15,363
Anesthesia service included in surgical procedure9,8731%3,109
Sequential procedure1,465<1%1,465
Laboratory panel100<1%100
Sex-specific procedures51<1%51

Modifier indicators and NCCI-associated modifiers

Each pair also carries a modifier indicator. Indicator 1 means an NCCI PTP-associated modifier can separate the two services when the clinical facts support it; indicator 0 means no modifier will. In the v323r0 (2026 Q4) tables 70% of practitioner pairs (1,219,525) and 96% of hospital outpatient pairs carry indicator 1. The manual lists the modifiers that count: the anatomic modifiers (E1-E4, FA, F1-F9, TA, T1-T9, LT, RT, LC, LD, RC, LM and RI), the global surgery modifiers 24, 25, 57, 58, 78 and 79, and 27, 59, 91, XE, XS, XP and XU. Modifiers 22, 76 and 77 never bypass a PTP edit. Indicator 9 marks a pair whose deletion date equals its effective date, so it is never applied. The modifier 59 entry explains when the X modifiers are the better choice.

Edit volume by code range

The policy manual assigns each code range to a chapter. Grouping the v323r0 (2026 Q4) practitioner table by the column-one code's range shows where the edits concentrate: Chapter IV (CPT 20000-29999) has the most pairs, 404,807.

Active practitioner PTP pairs and MUE codes by NCCI Policy Manual chapter code range
ChapterCode rangeColumn-1 codesActive pairsModifier allowedCodes with MUE
Chapter IICPT 00000-0199927682,72253%1
Chapter IIICPT 10000-1999942890,60073%428
Chapter IVCPT 20000-299991,648404,80773%1,650
Chapter VCPT 30000-399991,151261,93471%1,199
Chapter VICPT 40000-49999896210,02069%898
Chapter VIICPT 50000-59999772179,78468%786
Chapter VIIICPT 60000-69999955221,32667%968
Chapter IXCPT 70000-7999965227,37360%661
Chapter XCPT 80000-899991,64854,56594%1,666
Chapter XICPT 90000-999991,20478,73764%1,258
Chapter XIIHCPCS Level II A0000-V999934017,20765%4,618
Chapter XIIICPT Category III 0001T-0999T47557,81667%574
Codes outside the 13 chapter ranges (Category II, PLA and other suffixed CPT codes) account for 45,929 practitioner pairs. CPT codes are counted, never described.

Where the edits run

Medicare Administrative Contractors apply the practitioner PTP table to physician and other professional claims, and the same table is used for ambulatory surgical center claims. Hospital outpatient claims, and other institutional Part B claims such as outpatient therapy, are edited by the Integrated Outpatient Code Editor (I/OCE), which carries the hospital PTP table as edits 20 and 40. It applies the add-on code edits, 106 to 108, on the bill types its specification lists; on a standard OPPS hospital outpatient claim (bill type 013x) that is only edit 106, for remote mental health and software-as-a-service add-on codes. The I/OCE edit list shows what each of its 145 edit numbers does to the claim. Unit limits come from three MUE tables, one each for practitioner services, outpatient hospital services and DME suppliers, applied by the contractor that processes the claim. None of the PTP edits applies to an inpatient facility claim.

Because the edits are claim-level automation, they say nothing about medical necessity or coverage, which come from national and local coverage policies. They also do not stop a payer other than Medicare from bundling more: Medicare Advantage plans and commercial payers often start from the NCCI tables and add edits of their own.

The quarterly update cycle

CMS publishes complete new PTP and MUE files every quarter, effective January 1, April 1, July 1 and October 1, and the I/OCE ships a matching quarterly release. The add-on code edit file is published before January 1 each year and again in April, July or October when it changes. Each release adds pairs for codes that became effective that quarter, retires pairs that no longer apply and can change modifier indicators, which is why the checker reports the date each edit took effect. The policy manual is revised once a year, effective January 1; the 2026 edition added or removed 144 sentences against 2025, mostly to follow deleted codes, and the 2026 policy manual guide summarizes each chapter and what changed in it.

Medicaid NCCI

Section 6507 of the Affordable Care Act required state Medicaid programs to use NCCI methodologies, and CMS gave states instructions to do so by October 1, 2010. CMS publishes separate Medicaid edit files every quarter: PTP tables for practitioner, outpatient hospital and durable medical equipment services (Medicare has no DME pair table), and Medicaid MUE tables that carry a value and a rationale but no adjudication indicator. The Medicaid tables differ from Medicare's in places, so a claim that passes the Medicare checker can still deny under a state program. The figures on this page are the Medicare tables only.

Definitions

For a plain definition of each term, the glossary has a short entry; this hub stays with the data.

Where QuickIntell fits in correct coding

NCCI edits are applied claim by claim. QuickCode supports qualified coder review, documentation clarification and the billing handoff, where pair edits, unit limits and add-on rules are settled across the whole claim, and QuickRCM carries the edit-driven denials that still get through.

See QuickCode for pre-submission coder reviewSee QuickRCM for edit-driven denialsBook a meeting

Frequently asked questions

How often are NCCI edits updated?

CMS publishes complete Medicare PTP and MUE files every quarter, effective January 1, April 1, July 1 and October 1. The add-on code edit file is published before January 1 and again in a later quarter only when it changes, and the NCCI Policy Manual is revised once a year, effective January 1. A claim is edited against the tables in force on its date of service.

Do NCCI edits apply to hospital inpatient claims?

No. The manual states that the procedure-to-procedure edits are not applied to facility claims for inpatient services. They apply to practitioner claims, ambulatory surgical center claims and, through the Integrated Outpatient Code Editor, to hospital outpatient and other institutional Part B claims.

Can a patient be billed for a service an NCCI edit denies?

Not for a PTP denial. The manual treats these denials as coding decisions rather than medical-necessity decisions, so an Advance Beneficiary Notice cannot shift the liability to the beneficiary, and the service may not be billed to the Medicare patient.

What is the difference between a PTP edit and an MUE?

A procedure-to-procedure edit concerns two different codes reported for the same patient on the same date: the column-two code is denied unless a qualifying modifier applies. A Medically Unlikely Edit concerns one code: it caps the units of service reported for that code on one date, and its adjudication indicator says whether the cap applies per claim line or per day.

Where can I read the NCCI Policy Manual?

CMS publishes the manual as one PDF per chapter plus a combined file on its NCCI Policy Manual page. The policy manual guide on this site summarizes each chapter in plain language, with the code range it covers, the number of active edits in that range and a link to the chapter PDF.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

Operational reference compiled from the CMS NCCI quarterly files and the NCCI Policy Manual. Payment also depends on documentation, coverage policy and each payer's own edits. CPT codes appear as bare numbers. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.