How the manual is organized
Most chapters after the first follow one pattern: a short introduction that restates the general rules, a section on evaluation and management services and the global surgery package, the chapter's own topics, a section on Medically Unlikely Edits and a closing list of general policy statements. The anesthesia chapter is the exception, with no evaluation and management or MUE section. The topics are where the chapters differ, and they map onto code ranges, so the edit counts below are a fair guide to how much of the edit tables each chapter explains. The pair counts are for the column-one code's range; the full chapter text is in the CMS PDFs linked from each section.
| Part | Title | Code range | Pages | Active pairs | Modifier allowed | Changed sentences vs 2025 |
|---|---|---|---|---|---|---|
| Introduction | Introduction | — | 9 | — | — | 26 |
| Chapter I | General Correct Coding Policies | All HCPCS and CPT codes | 36 | — | — | 7 |
| Chapter II | Anesthesia Services | CPT 00000-01999 | 14 | 82,722 | 53% | 5 |
| Chapter III | Surgery: Integumentary System | CPT 10000-19999 | 16 | 90,600 | 73% | 2 |
| Chapter IV | Surgery: Musculoskeletal System | CPT 20000-29999 | 20 | 404,807 | 73% | 8 |
| Chapter V | Surgery: Respiratory, Cardiovascular, Hemic and Lymphatic Systems | CPT 30000-39999 | 23 | 261,934 | 71% | 12 |
| Chapter VI | Surgery: Digestive System | CPT 40000-49999 | 16 | 210,020 | 69% | 4 |
| Chapter VII | Surgery: Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems | CPT 50000-59999 | 16 | 179,784 | 68% | 0 |
| Chapter VIII | Surgery: Endocrine, Nervous, Eye and Ocular Adnexa, and Auditory Systems | CPT 60000-69999 | 22 | 221,326 | 67% | 7 |
| Chapter IX | Radiology Services | CPT 70000-79999 | 20 | 27,373 | 60% | 23 |
| Chapter X | Pathology/Laboratory Services | CPT 80000-89999 | 22 | 54,565 | 94% | 2 |
| Chapter XI | Medicine and Evaluation and Management Services | CPT 90000-99999 | 40 | 78,737 | 64% | 40 |
| Chapter XII | Supplemental Services | HCPCS Level II A0000-V9999 | 15 | 17,207 | 65% | 6 |
| Chapter XIII | Category III Codes | CPT Category III 0001T-0999T | 8 | 57,816 | 67% | 2 |
Using the manual with the edit tables
Read the manual when an edit surprises you. A pair in the NCCI edit checker names its rationale, such as a more extensive procedure or a mutually exclusive one, and the matching section of Chapter I explains the principle; the chapter for the code's range then gives the specific rule, for example which arthroscopy codes include a diagnostic arthroscopy or which services are part of an endoscopy. The manual also states rules that no edit enforces, and a provider is expected to follow them anyway. For unit questions the MUE lookup gives the current value and adjudication indicator, and for add-on codes the add-on code reference lists each code's edit type and primaries. The NCCI hub collects all of these.
Not every chapter changes every year: in the 2026 edition Chapter VII had no sentence added or removed.
Introduction to the manual
9 pages · revision date 2026-01-01 · CMS PDF (0-introduction-ncci-medicare-policy-manual-2026-final.pdf)
The introduction states what the program is for: stopping payment for code combinations and unit counts that correct coding does not support on Part B claims. It names the three edit types (procedure-to-procedure pairs, Medically Unlikely Edits and add-on code edits) and records the program's history: practitioner edits since 1996, the same edits added to the hospital Outpatient Code Editor in August 2000, MUEs from January 1, 2007, hospital and practitioner edits released in step since January 1, 2012, and Medicaid NCCI methodologies required of state programs by October 1, 2010 under section 6507 of the Affordable Care Act. It explains that CMS circulates proposed edits to national medical and surgical societies for comment, and sets two rules billers cite often: the edits are not applied to inpatient facility claims, and a service denied by a PTP edit cannot be billed to the beneficiary with an Advance Beneficiary Notice, because the denial is about coding rather than medical necessity.
Changes since 2025
13 sentences added and 13 removed. Editorial only: the 2026 text drops the article before "CMS" throughout and points appeals to the Appeals webpage. None of the revised sentences changes policy.
Chapter I: General Correct Coding Policies
All HCPCS and CPT codes · 36 pages · revision date 2026-01-01 · CMS PDF (01-chapter1-ncci-medicare-policy-manual-2026-final.pdf)
Chapter I is the rulebook the other chapters apply. It explains the edit rationales one by one: services integral to a procedure under standards of medical and surgical practice, the medical and surgical package, the separate-procedure convention, families of codes, more extensive and sequential procedures, laboratory panels, mutually exclusive procedures and misuse of a column-two code with a column-one code. A long section on modifiers lists the NCCI PTP-associated modifiers that can bypass an edit with indicator 1 (anatomic modifiers such as E1-E4, F1-F9, T1-T9, LT and RT; the global surgery modifiers 24, 25, 57, 58, 78 and 79; and 27, 59, 91, XE, XS, XP and XU), states that 22, 76 and 77 never bypass an edit, and defines modifier indicator 9 as the value for pairs deleted on the day they took effect. It closes with how MUEs and their adjudication indicators work and with the three add-on code edit types.
Sections
A. Introduction · B. Coding Based on Standards of Medical/Surgical Practice · C. Medical/Surgical Package · D. Evaluation & Management (E&M) Services · E. Modifiers and Modifier Indicators · F. Standard Preparation/Monitoring Services for Anesthesia · G. Anesthesia Service Included in the Surgical Procedure · H. HCPCS/CPT Procedure Code Definition · I. CPT Professional Codebook and CMS Coding Manual Instructions · J. CPT “Separate Procedure” Definition · K. Family of Codes · L. More Extensive Procedure · M. Sequential Procedure · N. Laboratory Panel · O. Misuse of Column Two Code with Column One Code (Misuse of Code Edit Rationale) · P. Mutually Exclusive Procedures · R. Add-on Codes · S. Excluded Service · T. Unlisted Procedure Codes · V. Medically Unlikely Edits (MUEs) · W. Add-on Code Edits
Changes since 2025
3 sentences added and 4 removed. Wording only: the rule against fragmenting a procedure now applies to the "provider/supplier" rather than the "physician", and the modifier guidance refers to "NCCI PTP-associated" modifiers.
Chapter II: Anesthesia Services
CPT 00000-01999 · 14 pages · revision date 2026-01-01 · CMS PDF (02-chapter2-ncci-medicare-policy-manual-2026-final.pdf)
Chapter II applies the general rules to anesthesia codes. Medicare accepts one anesthesia code per session unless the second is an add-on code, and anesthesia is paid on base units plus time, so the chapter defines when anesthesia time starts and stops. It lists services that are part of anesthesia care when done during it, such as electrocardiographic and echocardiographic monitoring, ventilation management, oximetry and drug administration, and says when a diagnostic study with a formal report can still be reported. It limits anesthesia for radiological procedures to one anesthesia code however many imaging procedures are done, covers monitored anesthesia care, and applies the Medicare rule that the physician performing a procedure does not separately report anesthesia for it.
Sections
A. Introduction · B. Standard Anesthesia Coding · C. Radiologic Anesthesia Coding · D. Monitored Anesthesia Care · E. General Policy Statements
Edits in this range
In the v323r0 (2026 Q4) practitioner table, 276 codes in this range are column one in 82,722 active pairs, and 53% of those pairs allow a modifier. Almost every bundled column-two code in those pairs belongs to another chapter's range. The hospital outpatient table has 77,805 pairs for the range (99.9% modifier-allowed). The practitioner MUE table publishes a value for only one code in this range. The range holds 3 add-on codes in the add-on code edit file.
Most common rationales: Standard preparation/monitoring services for anesthesia (70,523); Misuse of Column Two code with Column One code (6,900); CPT Manual or CMS manual coding instruction (5,296).
Most-bundled column-two codes from the same range
Most-bundled column-two codes overall
Changes since 2025
3 sentences added and 2 removed. A note that 94662 was deleted on January 1, 2026 was added to the list of services included in anesthesia care, and a sentence on radiological supervision and interpretation codes was reworded.
Chapter III: Surgery: Integumentary System
CPT 10000-19999 · 16 pages · revision date 2026-01-01 · CMS PDF (03-chapter3-ncci-medicare-policy-manual-2026-final.pdf)
Chapter III covers the integumentary system. Incision and drainage done to reach another operative site is part of that procedure; Mohs micrographic surgery (17311-17315) is reported by the one physician who does both the excision and the pathology; repairs are classed as simple, intermediate or complex, and most graft and skin-substitute families pair a primary code with one or two add-on codes. The breast section explains why a mastectomy (19300-19307) includes the breast excisions (19110-19126) done on the same breast. Sections on lesion removal, intralesional injections, grafts and flaps, MUEs and general policy statements complete the chapter.
Sections
A. Introduction · B. Evaluation & Management (E&M) Services · C. Anesthesia · D. Incision and Drainage · E. Lesion Removal · F. Mohs Micrographic Surgery · G. Intralesional Injections · H. Repair and Tissue Transfer · I. Grafts and Flaps · J. Breast (Incision, Excision, Introduction, Repair and Reconstruction) · K. Medically Unlikely Edits (MUEs) · L. General Policy Statements
Edits in this range
In the v323r0 (2026 Q4) practitioner table, 428 codes in this range are column one in 90,600 active pairs, and 73% of those pairs allow a modifier. In 22% of those pairs the bundled column-two code comes from the same range; in the rest it is a service from another chapter's range. The hospital outpatient table has 71,473 pairs for the range (99% modifier-allowed). Practitioner MUEs are published for 428 codes in the range; 428 of them are date-of-service edits (adjudication indicator 2 or 3) and 231 allow a single unit. The range holds 69 add-on codes in the add-on code edit file.
Most common rationales: Misuse of Column Two code with Column One code (33,366); Standards of medical/surgical practice (26,940); CPT Manual or CMS manual coding instruction (23,911).
Most-bundled column-two codes from the same range
Most-bundled column-two codes overall
Changes since 2025
1 sentence added and 1 removed. One sentence was revised: the paired-organ guidance now refers to "NCCI PTP-associated" modifiers.
Chapter IV: Surgery: Musculoskeletal System
CPT 20000-29999 · 20 pages · revision date 2026-01-01 · CMS PDF (04-chapter4-ncci-medicare-policy-manual-2026-final.pdf)
Chapter IV covers the musculoskeletal system. Surgical arthroscopy includes diagnostic arthroscopy of the same joint, and exploring the surgical field is not reported separately. The spine section deals with the many combinations of approach, levels and instrumentation, and the fracture section explains that a cast or splint applied at the time of a procedure includes its later removal by the same practice, so the removal and repair codes (29700-29750) are not reported for it. Pairs made of two shoulder procedures on the same shoulder are not bypassed with a modifier, with three exceptions the chapter names.
Sections
A. Introduction · B. Evaluation & Management (E&M) Services · C. Anesthesia · D. Biopsy · E. Arthroscopy · F. Spine (Vertebral Column) · G. Fractures, Dislocations, and Casting/Splinting/Strapping · H. Medically Unlikely Edits (MUEs) · I. General Policy Statements
Edits in this range
In the v323r0 (2026 Q4) practitioner table, 1,648 codes in this range are column one in 404,807 active pairs, and 73% of those pairs allow a modifier. In 8% of those pairs the bundled column-two code comes from the same range; in the rest it is a service from another chapter's range. The hospital outpatient table has 317,457 pairs for the range (99% modifier-allowed). Practitioner MUEs are published for 1,650 codes in the range; 1,650 of them are date-of-service edits (adjudication indicator 2 or 3) and 1,208 allow a single unit. The range holds 53 add-on codes in the add-on code edit file.
Most common rationales: Misuse of Column Two code with Column One code (154,197); Standards of medical/surgical practice (136,328); CPT Manual or CMS manual coding instruction (97,641).
Most-bundled column-two codes from the same range
Most-bundled column-two codes overall
Changes since 2025
3 sentences added and 5 removed. The deleted code 92585 was removed from the examples of intraoperative neurophysiology testing that the global package includes, and the shoulder rule now refers to "NCCI PTP-associated" modifiers.
Chapter V: Surgery: Respiratory, Cardiovascular, Hemic and Lymphatic Systems
CPT 30000-39999 · 23 pages · revision date 2026-01-01 · CMS PDF (05-chapter5-ncci-medicare-policy-manual-2026-final.pdf)
Chapter V spans the respiratory, cardiovascular, hemic and lymphatic systems and the mediastinum. Coronary bypass codes that use vein grafts (33510-33523) include harvesting the vein; open and endovascular vascular procedures follow a "most comprehensive code per vessel" rule, and when a percutaneous attempt fails and is converted to an open procedure only the completed procedure is reported. Diagnostic bone marrow aspiration done alone is 38220, and mediastinal exploration (39000, 39010) is not reported with procedures performed through the mediastinum.
Sections
A. Introduction · B. Evaluation & Management (E&M) Services · C. Respiratory System · D. Cardiovascular System · E. Hemic and Lymphatic Systems · F. Mediastinum · G. Medically Unlikely Edits (MUEs) · H. General Policy Statements
Edits in this range
In the v323r0 (2026 Q4) practitioner table, 1,151 codes in this range are column one in 261,934 active pairs, and 71% of those pairs allow a modifier. In 13% of those pairs the bundled column-two code comes from the same range; in the rest it is a service from another chapter's range. The hospital outpatient table has 210,477 pairs for the range (97% modifier-allowed). Practitioner MUEs are published for 1,199 codes in the range; 1,199 of them are date-of-service edits (adjudication indicator 2 or 3) and 996 allow a single unit. The range holds 115 add-on codes in the add-on code edit file.
Most common rationales: Misuse of Column Two code with Column One code (115,535); CPT Manual or CMS manual coding instruction (67,274); Standards of medical/surgical practice (66,599).
Most-bundled column-two codes from the same range
Most-bundled column-two codes overall
Changes since 2025
7 sentences added and 5 removed. Most revisions follow the January 1, 2026 replacement of the lower-extremity revascularization codes: references to 37220-37235 now point to 37254-37299, the atherectomy examples list 37271-37278 and 37288-37295, and deletion notes were added for the retired codes.
Chapter VI: Surgery: Digestive System
CPT 40000-49999 · 16 pages · revision date 2026-01-01 · CMS PDF (06-chapter6-ncci-medicare-policy-manual-2026-final.pdf)
Chapter VI covers the digestive system. Venous access, infusions, oximetry and anesthesia given by the endoscopist are part of an endoscopic procedure; a diagnostic endoscopy is included in a surgical endoscopy of the same session; an exploratory laparotomy (49000) is not reported with an open abdominal procedure; and a surgical laparoscopy includes the diagnostic laparoscopy that led to it. Esophageal procedures, MUEs and general policy statements complete the chapter.
Sections
A. Introduction · B. Evaluation & Management (E&M) Services · C. Endoscopic Services · D. Esophageal Procedures · E. Abdominal Procedures · F. Laparoscopy · G. Medically Unlikely Edits (MUEs) · H. General Policy Statements
Edits in this range
In the v323r0 (2026 Q4) practitioner table, 896 codes in this range are column one in 210,020 active pairs, and 69% of those pairs allow a modifier. In 8% of those pairs the bundled column-two code comes from the same range; in the rest it is a service from another chapter's range. The hospital outpatient table has 166,630 pairs for the range (94% modifier-allowed). Practitioner MUEs are published for 898 codes in the range; 898 of them are date-of-service edits (adjudication indicator 2 or 3) and 762 allow a single unit. The range holds 24 add-on codes in the add-on code edit file.
Most common rationales: Misuse of Column Two code with Column One code (86,974); Standards of medical/surgical practice (59,884); CPT Manual or CMS manual coding instruction (48,858).
Most-bundled column-two codes from the same range
Most-bundled column-two codes overall
Changes since 2025
2 sentences added and 2 removed. 0963T was added to the anal procedures that include diagnostic anoscopy, and the sentence on a separate laryngoscopy during esophagoscopy was reworded.
Chapter VII: Surgery: Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems
CPT 50000-59999 · 16 pages · revision date 2026-01-01 · CMS PDF (07-chapter7-ncci-medicare-policy-manual-2026-final.pdf)
Chapter VII covers the urinary, male and female genital systems and maternity care. Bladder catheterization (51701-51703) at the time of a procedure is part of the procedure; a pelvic examination that is part of a gynecologic procedure is not reported separately; and the global obstetric packages (for example 59400 and 59510) include antepartum care, delivery and postpartum care but not services such as ultrasound or amniocentesis. Laparoscopy follows the same rule as the other surgical chapters.
Sections
A. Introduction · B. Evaluation & Management (E&M) Services · C. Urinary System · D. Male Genital System · E. Female Genital System · F. Laparoscopy · G. Maternity Care and Delivery · H. Medically Unlikely Edits (MUEs) · I. General Policy Statements
Edits in this range
In the v323r0 (2026 Q4) practitioner table, 772 codes in this range are column one in 179,784 active pairs, and 68% of those pairs allow a modifier. In 6% of those pairs the bundled column-two code comes from the same range; in the rest it is a service from another chapter's range. The hospital outpatient table has 141,466 pairs for the range (93% modifier-allowed). Practitioner MUEs are published for 786 codes in the range; 786 of them are date-of-service edits (adjudication indicator 2 or 3) and 735 allow a single unit. The range holds 12 add-on codes in the add-on code edit file.
Most common rationales: Misuse of Column Two code with Column One code (73,727); Standards of medical/surgical practice (52,579); CPT Manual or CMS manual coding instruction (43,306).
Most-bundled column-two codes from the same range
Most-bundled column-two codes overall
Changes since 2025
No sentence was added or removed.
Chapter VIII: Surgery: Endocrine, Nervous, Eye and Ocular Adnexa, and Auditory Systems
CPT 60000-69999 · 22 pages · revision date 2026-01-01 · CMS PDF (08-chapter8-ncci-medicare-policy-manual-2026-final.pdf)
Chapter VIII covers the endocrine and nervous systems, the eye and the ear. A burr hole made to reach the brain is part of the intracranial procedure; a subconjunctival injection given as part of a regional eye block is part of the block; a myringotomy is included in tympanoplasty and tympanostomy; and the operating microscope add-on (69990) may be reported only with the neurosurgical and peripheral nerve code ranges listed in the Medicare Claims Processing Manual, chapter 12, section 20.4.5.
Sections
A. Introduction · B. Evaluation & Management (E&M) Services · C. Nervous System · D. Ophthalmology · E. Auditory System · F. Operating Microscope · G. Laparoscopy · H. Medically Unlikely Edits (MUEs) · I. General Policy Statements
Edits in this range
In the v323r0 (2026 Q4) practitioner table, 955 codes in this range are column one in 221,326 active pairs, and 67% of those pairs allow a modifier. In 24% of those pairs the bundled column-two code comes from the same range; in the rest it is a service from another chapter's range. The hospital outpatient table has 176,723 pairs for the range (99% modifier-allowed). Practitioner MUEs are published for 968 codes in the range; 968 of them are date-of-service edits (adjudication indicator 2 or 3) and 812 allow a single unit. The range holds 75 add-on codes in the add-on code edit file.
Most common rationales: Misuse of Column Two code with Column One code (89,358); Standards of medical/surgical practice (68,029); CPT Manual or CMS manual coding instruction (55,821).
Most-bundled column-two codes from the same range
Most-bundled column-two codes overall
Changes since 2025
3 sentences added and 4 removed. The deleted code 92585 was dropped from the intraoperative neurophysiology examples, and an ophthalmic injection example was reworded.
Chapter IX: Radiology Services
CPT 70000-79999 · 20 pages · revision date 2026-01-01 · CMS PDF (09-chapter9-ncci-medicare-policy-manual-2026-final.pdf)
Chapter IX covers radiology. The code that best describes the views actually taken is reported for a radiographic series; contrast given by mouth or rectum is part of the study, and for contrast given intravenously the vascular access and the injection are part of the study; the injection of a radiopharmaceutical is part of a nuclear medicine procedure. In radiation oncology, evaluation and management services are generally included in treatment management except for the initial visit at which the decision to treat is made.
Sections
A. Introduction · B. Evaluation & Management (E&M) Services · C. Non-interventional Diagnostic Imaging · D. Interventional/Invasive Diagnostic Imaging · E. Nuclear Medicine · F. Radiation Oncology · G. Medically Unlikely Edits (MUEs) · H. General Policy Statements
Edits in this range
In the v323r0 (2026 Q4) practitioner table, 652 codes in this range are column one in 27,373 active pairs, and 60% of those pairs allow a modifier. In 20% of those pairs the bundled column-two code comes from the same range; in the rest it is a service from another chapter's range. The hospital outpatient table has 13,313 pairs for the range (84% modifier-allowed). Practitioner MUEs are published for 661 codes in the range; 661 of them are date-of-service edits (adjudication indicator 2 or 3) and 472 allow a single unit. The range holds 27 add-on codes in the add-on code edit file.
Most common rationales: CPT Manual or CMS manual coding instruction (9,910); Standards of medical/surgical practice (9,388); Misuse of Column Two code with Column One code (5,239).
Most-bundled column-two codes from the same range
Most-bundled column-two codes overall
Changes since 2025
13 sentences added and 10 removed. More sentences changed here than in any other procedure chapter. After the January 1, 2026 deletion of 77014, 77385, 77386, G6001 and G6015, the paragraphs on image guidance for radiation therapy were replaced by deletion notes or marked "Reserved for future use", and "calcaneus" was corrected in the foot radiography rule.
Chapter X: Pathology/Laboratory Services
CPT 80000-89999 · 22 pages · revision date 2026-01-01 · CMS PDF (10-chapter10-ncci-medicare-policy-manual-2026-final.pdf)
Chapter X covers pathology and laboratory services. When every test in a CPT-defined panel is performed the panel code is billed; presumptive drug testing is reported with 80305-80307 according to the complexity of the method; physician interpretation of molecular pathology can be reported with G0452 but not with 88291; a blood smear examined to complete an automated count (85025, 85027) is not reported as 85007 or 85008; and blood product P codes already include irradiation and CMV testing. Its MUE section, one of the longest in the manual, sets unit rules for specific pathology codes.
Sections
A. Introduction · B. Evaluation & Management (E&M) Services · C. Organ or Disease Oriented Panels · D. Evocative/Suppression Testing · E. Drug Testing · F. Molecular Pathology · G. Chemistry · H. Hematology and Coagulation · I. Immunology · J. Transfusion Medicine · K. Microbiology · L. Anatomic Pathology (Cytopathology and Surgical Pathology) · M. Medically Unlikely Edits (MUEs) · N. General Policy Statements
Edits in this range
In the v323r0 (2026 Q4) practitioner table, 1,648 codes in this range are column one in 54,565 active pairs, and 94% of those pairs allow a modifier. In 82% of those pairs the bundled column-two code comes from the same range; in the rest it is a service from another chapter's range. The hospital outpatient table has 53,114 pairs for the range (97% modifier-allowed). Practitioner MUEs are published for 1,666 codes in the range; 1,666 of them are date-of-service edits (adjudication indicator 2 or 3) and 1,119 allow a single unit. The range holds 22 add-on codes in the add-on code edit file.
Most common rationales: CPT Manual or CMS manual coding instruction (27,493); Misuse of Column Two code with Column One code (22,831); Standards of medical/surgical practice (1,809).
Most-bundled column-two codes from the same range
Most-bundled column-two codes overall
Changes since 2025
1 sentence added and 1 removed. One sentence was revised: the rule for gene panels was shortened to "one unit of service for that CPT code" when one procedure evaluates multiple genes.
Chapter XI: Medicine and Evaluation and Management Services
CPT 90000-99999 · 40 pages · revision date 2026-01-01 · CMS PDF (11-chapter11a-ncci-medicare-policy-manual-2026-final.pdf)
Chapter XI, the longest chapter, covers medicine and evaluation and management. Only one "initial" infusion, injection or chemotherapy administration code is reported per encounter unless separate intravenous sites are medically necessary; psychiatric diagnostic evaluations (90791, 90792) are not reported with psychotherapy on the same day; dialysis codes include the related evaluation and management; and therapists report one evaluation or re-evaluation per date. Further sections cover cardiovascular, pulmonary, allergy, neurology and rehabilitation services, and the E&M section sets out which visits can be reported together on one date.
Sections
A. Introduction · B. Therapeutic or Diagnostic Infusions/Injections and Immunizations · C. Psychiatric Services · D. Biofeedback · E. Dialysis · F. Gastroenterology · G. Ophthalmology · H. Otorhinolaryngologic Services · I. Cardiovascular Services · J. Pulmonary Services · K. Allergy Testing and Immunotherapy · L. Neurology and Neuromuscular Procedures · M. Central Nervous System (CNS) Assessments/Tests · N. Chemotherapy Administration · O. Special Dermatological Procedures · P. Physical Medicine and Rehabilitation · Q. Medical Nutrition Therapy · R. Osteopathic Manipulative Treatment · S. Chiropractic Manipulative Treatment · T. Miscellaneous Services · U. Evaluation & Management (E&M) Services · V. Medically Unlikely Edits (MUEs) · W. General Policy Statements
Edits in this range
In the v323r0 (2026 Q4) practitioner table, 1,204 codes in this range are column one in 78,737 active pairs, and 64% of those pairs allow a modifier. In 59% of those pairs the bundled column-two code comes from the same range; in the rest it is a service from another chapter's range. The hospital outpatient table has 65,516 pairs for the range (91% modifier-allowed). Practitioner MUEs are published for 1,258 codes in the range; 1,257 of them are date-of-service edits (adjudication indicator 2 or 3) and 899 allow a single unit. The range holds 148 add-on codes in the add-on code edit file.
Most common rationales: CPT Manual or CMS manual coding instruction (33,772); Misuse of Column Two code with Column One code (23,217); Standards of medical/surgical practice (14,601).
Most-bundled column-two codes from the same range
Most-bundled column-two codes overall
Changes since 2025
18 sentences added and 22 removed. The chapter has the most revisions of the 2026 edition. Vaccine administration codes 90480 and 90481 were added to the list that 99211 is not reported with, deletion notes were added for 94662 and 91122, the 91122 paragraph was replaced by its deletion note, and the 92941 paragraph now says the code is for emergent revascularization during an acute myocardial infarction, not for non-emergent PCI.
Chapter XII: Supplemental Services
HCPCS Level II A0000-V9999 · 15 pages · revision date 2026-01-01 · CMS PDF (12-chapter12-ncci-medicare-policy-manual-2026-final.pdf)
Chapter XII applies correct coding to HCPCS Level II codes: drugs, supplies, durable equipment, ambulance and CMS-defined services. It explains, for example, that a digital rectal prostate screening (G0102) is not paid separately on the day of a covered evaluation and management visit, that a screening pelvic and breast examination (G0101) and a Pap smear collection (Q0091) can be reported with a visit only when the visit is significant and separately identifiable (modifier 25), and that drug units must match the HCPCS dosage descriptor. Level II codes make up the largest block of the MUE table.
Sections
A. Introduction · B. Evaluation & Management (E&M) Services · C. NCCI Procedure-to-Procedure (PTP) Edit Specific Issues · D. Medically Unlikely Edits (MUEs) · E. General Policy Statements
Edits in this range
In the v323r0 (2026 Q4) practitioner table, 340 codes in this range are column one in 17,207 active pairs, and 65% of those pairs allow a modifier. In 6% of those pairs the bundled column-two code comes from the same range; in the rest it is a service from another chapter's range. The hospital outpatient table has 14,219 pairs for the range (87% modifier-allowed). Practitioner MUEs are published for 4,618 codes in the range; 4,578 of them are date-of-service edits (adjudication indicator 2 or 3) and 794 allow a single unit. The range holds 42 add-on codes in the add-on code edit file.
Most common rationales: Misuse of Column Two code with Column One code (5,945); Standards of medical/surgical practice (5,194); CPT Manual or CMS manual coding instruction (3,566).
Most-bundled column-two codes from the same range
Most-bundled column-two codes overall
Changes since 2025
4 sentences added and 2 removed. Deletion notes were added for J0171 (deleted July 1, 2025) and J1094 (deleted April 1, 2025) in the drug-units examples.
Chapter XIII: Category III Codes
CPT Category III 0001T-0999T · 8 pages · revision date 2026-01-01 · CMS PDF (13-chapter13-ncci-medicare-policy-manual-2026-final.pdf)
Chapter XIII covers Category III codes (0001T-0999T), the temporary codes for emerging technology. The coding policies are those of the CPT section the code relates to: a Category III laboratory code, for example, follows Chapter I and Chapter X. The chapter adds a short list of edit-specific issues, its own MUE notes and the general policy statements every chapter repeats.
Sections
A. Introduction · B. Evaluation & Management (E&M) Services · C. NCCI Procedure-to-Procedure (PTP) Edit Specific Issues · D. Medically Unlikely Edits (MUEs) · E. General Policy Statements
Edits in this range
In the v323r0 (2026 Q4) practitioner table, 475 codes in this range are column one in 57,816 active pairs, and 67% of those pairs allow a modifier. In 6% of those pairs the bundled column-two code comes from the same range; in the rest it is a service from another chapter's range. The hospital outpatient table has 52,755 pairs for the range (93% modifier-allowed). Practitioner MUEs are published for 574 codes in the range; 574 of them are date-of-service edits (adjudication indicator 2 or 3) and 499 allow a single unit. The range holds 112 add-on codes in the add-on code edit file.
Most common rationales: Misuse of Column Two code with Column One code (34,002); CPT Manual or CMS manual coding instruction (15,708); Standards of medical/surgical practice (5,424).
Most-bundled column-two codes from the same range
Most-bundled column-two codes overall
Changes since 2025
1 sentence added and 1 removed. A paragraph on radiation-therapy localization codes gave way to one stating that V2790 (amniotic membrane) is not reported with 65778 or 65779, whose payment already includes the membrane.
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.
Frequently asked questions
Is the NCCI Policy Manual the same as the NCCI edit tables?
No. The manual explains the coding principles and specific rules behind the edits, chapter by chapter. The edits themselves are published separately every quarter as procedure-to-procedure tables, Medically Unlikely Edit tables and the add-on code edit file. A rule in the manual applies even where no edit enforces it.
How often is the NCCI Policy Manual updated?
Once a year. Each edition takes effect on January 1 and every page carries a Medicare revision date. CMS keeps earlier editions on its website so a claim can be read against the rules that applied on its date of service.
Why does this guide summarize instead of quoting the manual?
The manual reproduces CPT code descriptors, which are copyrighted by the American Medical Association. This guide describes each chapter in its own words, shows code numbers only and links to the CMS PDF for the authoritative text.
Which chapter covers HCPCS Level II codes and which covers Category III codes?
Chapter XII (Supplemental Services) covers HCPCS Level II codes A0000 to V9999. Chapter XIII covers CPT Category III codes 0001T to 0999T and applies the policies of the CPT section each code relates to.
Where do I check whether two specific codes are bundled?
Use the NCCI edit checker. The manual tells you why pairs exist; the checker reads the current quarter's practitioner or hospital outpatient table and returns the column-one code, the modifier indicator, the rationale and the date the edit took effect.
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.
- Medicare NCCI Policy Manual, 2026 edition (Introduction and Chapters I-XIII)Version 2026 edition · effective 2026-01-01 · file 2026-ncci-medicare-policy-manual-all-chapters.pdfSHA-256 f9edd797151d2270…
- NCCI PTP edits, practitioner, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccipra-v323r0-f1.TXTSHA-256 7793c0b6686c1e22…
- NCCI PTP edits, hospital outpatient, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccioph-v323r0-f1.txtSHA-256 063f41b91ef9faa2…
- NCCI MUE table, practitioner services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_PractitionerServices_Eff_10-01-2026.csvSHA-256 ef038efaf902b7bd…
- NCCI Add-On Code edits, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file AOC_V2026Q4-F-MCR.xlsxSHA-256 eabb519623134549…
Disclaimer
Plain-language summaries of a CMS manual, with edit counts computed from the CMS quarterly files. The CMS PDFs are the authoritative text. CPT codes appear as bare numbers; CPT descriptors are copyright AMA. 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.