Headline numbers
- Practitioner pairs added
- 4,249
- 604 column-1 codes
- Hospital pairs added
- 4,146
- 604 column-1 codes
- Pairs deleted
- 14
- per setting; end-dated 2026-09-30
- Edits re-flagged
- 7
- modifier indicator or rationale
- Practitioner MUEs added
- 51
- 31 revised, 1 deleted
- New pairs allowing a modifier
- 63.8%
- practitioner table
Which codes the new pairs edit
Most of the quarter's new edits sit on temporary category III codes: 2,728 of the 4,249 practitioner additions (64.2%) have a category III code in column 1. CPT category I, proprietary laboratory analysis (PLA) and HCPCS Level II codes make up the rest, in the proportions below.
| Column-1 code set | Practitioner pairs | Hospital pairs |
|---|---|---|
| CPT category III | 2,728 | 2,625 |
| CPT category I | 1,056 | 1,056 |
| Proprietary laboratory analyses (PLA) | 402 | 402 |
| HCPCS Level II | 63 | 63 |
Why CMS added them
Each pair in the full PTP file carries an edit rationale. Joining the additions to the v323r0 files gives the reason for every new pair: 2,922 practitioner pairs cite misuse of the column-2 code with the column-1 code, meaning the column-2 service should not be reported separately when it is part of the column-1 service. 2,710 of the new practitioner pairs (63.8%) allow an NCCI-associated modifier and 1,539 do not.
| PTP edit rationale | Practitioner | Hospital outpatient |
|---|---|---|
| Misuse of Column Two code with Column One code | 2,922 | 2,863 |
| CPT Manual or CMS manual coding instruction | 1,038 | 1,025 |
| Mutually exclusive procedures | 140 | 138 |
| CPT Separate procedure definition | 41 | 41 |
| HCPCS/CPT procedure code definition | 37 | 37 |
| Anesthesia service included in surgical procedure | 29 | 0 |
| Standard preparation/monitoring services for anesthesia | 27 | 27 |
| More extensive procedure | 15 | 15 |
| Modifier indicator | Practitioner | Hospital outpatient |
|---|---|---|
| 0 (no modifier bypass) | 1,539 | 947 |
| 1 (modifier allowed) | 2,710 | 3,199 |
Codes with the most new pairs
Column-1 codes are the comprehensive services; each new pair means one more code that is bundled into them on the same date of service. Every code opens in the NCCI checker, where any pair can be tested in either setting.
| Column 1 | Code set or descriptor | New pairs | Modifier allowed |
|---|---|---|---|
| 0942T | CPT category III code (descriptor licensed by AMA) | 276 | 126 |
| 0933T | CPT category III code (descriptor licensed by AMA) | 248 | 172 |
| 0941T | CPT category III code (descriptor licensed by AMA) | 233 | 126 |
| 0930T | CPT category III code (descriptor licensed by AMA) | 226 | 160 |
| 0931T | CPT category III code (descriptor licensed by AMA) | 223 | 160 |
| 0943T | CPT category III code (descriptor licensed by AMA) | 213 | 121 |
| 0935T | CPT category III code (descriptor licensed by AMA) | 210 | 111 |
| 0936T | CPT category III code (descriptor licensed by AMA) | 189 | 117 |
| 0944T | CPT category III code (descriptor licensed by AMA) | 152 | 82 |
| 0947T | CPT category III code (descriptor licensed by AMA) | 148 | 114 |
| 0530U | PLA code (descriptor licensed by AMA) | 119 | 112 |
| 0523U | PLA code (descriptor licensed by AMA) | 97 | 94 |
| 0928T | CPT category III code (descriptor licensed by AMA) | 60 | 40 |
| 81558 | CPT code (descriptor licensed by AMA) | 57 | 52 |
| 0934T | CPT category III code (descriptor licensed by AMA) | 51 | 48 |
Column-2 codes are the components: these codes became bundled into the largest number of new comprehensive services this quarter.
| Column 2 | Code set or descriptor | New pairs |
|---|---|---|
| 0929T | CPT category III code (descriptor licensed by AMA) | 110 |
| 0930T | CPT category III code (descriptor licensed by AMA) | 95 |
| 0928T | CPT category III code (descriptor licensed by AMA) | 88 |
| 0931T | CPT category III code (descriptor licensed by AMA) | 87 |
| 0938T | CPT category III code (descriptor licensed by AMA) | 84 |
| 0939T | CPT category III code (descriptor licensed by AMA) | 83 |
| 0940T | CPT category III code (descriptor licensed by AMA) | 83 |
| 0937T | CPT category III code (descriptor licensed by AMA) | 80 |
| 0943T | CPT category III code (descriptor licensed by AMA) | 67 |
| 0934T | CPT category III code (descriptor licensed by AMA) | 62 |
| 0932T | CPT category III code (descriptor licensed by AMA) | 59 |
| 0906T | CPT category III code (descriptor licensed by AMA) | 54 |
| 0912T | CPT category III code (descriptor licensed by AMA) | 51 |
| 36591 | CPT code (descriptor licensed by AMA) | 38 |
| 36592 | CPT code (descriptor licensed by AMA) | 38 |
14 pairs deleted
Deleted pairs stay in the CMS file with a deletion date, so claims with earlier dates of service are still edited. 11 of the 14 deletions have 20704 as the column-2 code. Each pair below links to the checker, which shows the current status for any date of service.
| Column 1 / column 2 | Modifier indicator | Rationale | In effect |
|---|---|---|---|
| 23473 / 20704 | 1 | Misuse of Column Two code with Column One code | 2020-01-01 to 2026-09-30 |
| 23474 / 20704 | 1 | Misuse of Column Two code with Column One code | 2020-01-01 to 2026-09-30 |
| 24370 / 20704 | 1 | Misuse of Column Two code with Column One code | 2020-01-01 to 2026-09-30 |
| 24371 / 20704 | 1 | Misuse of Column Two code with Column One code | 2020-01-01 to 2026-09-30 |
| 25449 / 20704 | 1 | Misuse of Column Two code with Column One code | 2020-01-01 to 2026-09-30 |
| 27132 / 20704 | 1 | Misuse of Column Two code with Column One code | 2020-01-01 to 2026-09-30 |
| 27134 / 20704 | 1 | Misuse of Column Two code with Column One code | 2020-01-01 to 2026-09-30 |
| 27137 / 20704 | 1 | Misuse of Column Two code with Column One code | 2020-01-01 to 2026-09-30 |
| 27138 / 20704 | 1 | Misuse of Column Two code with Column One code | 2020-01-01 to 2026-09-30 |
| 27487 / 20704 | 1 | Misuse of Column Two code with Column One code | 2020-01-01 to 2026-09-30 |
| 27703 / 20704 | 1 | Misuse of Column Two code with Column One code | 2020-01-01 to 2026-09-30 |
| 36904 / 36836 | 1 | Mutually exclusive procedures | 2023-01-01 to 2026-09-30 |
| 36905 / 36836 | 1 | Mutually exclusive procedures | 2023-01-01 to 2026-09-30 |
| 36906 / 36836 | 1 | Mutually exclusive procedures | 2023-01-01 to 2026-09-30 |
The hospital outpatient table deleted the same 14 pairs.
7 edits re-flagged
CMS re-flags an edit by end-dating the old row and adding the pair again with a new modifier indicator or rationale. A change from 1 to 0 is the one that hurts: a modifier that used to bypass the edit no longer does, so claims that relied on 59 or an X modifier for these pairs now deny.
| Column 1 / column 2 | Modifier indicator | Rationale |
|---|---|---|
| 33274 / 75820 | 1 → 0 | CPT Manual or CMS manual coding instruction |
| 33275 / 75820 | 1 → 0 | CPT Manual or CMS manual coding instruction |
| 36836 / 36005 | 1 → 1 | Misuse of Column Two code with Column One code → CPT Manual or CMS manual coding instruction |
| 36836 / 36901 | 1 → 0 | CPT Manual or CMS manual coding instruction |
| 36836 / 36902 | 1 → 0 | CPT Manual or CMS manual coding instruction |
| 36836 / 36903 | 1 → 0 | CPT Manual or CMS manual coding instruction |
| 36837 / 36005 | 1 → 1 | Misuse of Column Two code with Column One code → CPT Manual or CMS manual coding instruction |
Practitioner and hospital outpatient tables
The two tables moved together: 4,146 of the new pairs were added to both, 103 only to the practitioner table and 0 only to the hospital outpatient table. After the release the practitioner table holds 1,732,820 active pairs and the hospital outpatient table 1,406,699. Facilities that bill both professional and facility claims for the same encounter need both checks; the most-bundled codes report shows which column-2 codes carry the most active pairs in each table.
MUE changes
| MUE table | Added | Deleted | Revised |
|---|---|---|---|
| Practitioner | 51 | 1 | 31 |
| Outpatient hospital | 51 | 1 | 32 |
| DME supplier | 29 | 0 | 3 |
Every code CMS added, deleted or revised in any of the three MUE tables, with the value the change file publishes and the adjudication indicator from the full 2026 Q4 table. CMS publishes the new value of a revised edit, not the old one. A revised value with indicator 2 or 3 applies to the whole date of service. Look any code up in the MUE lookup tool.
| Code | Code set or descriptor | Practitioner | Outpatient hospital | DME supplier |
|---|---|---|---|---|
| 0914T | CPT category III code (descriptor licensed by AMA) | revised: 2 (MAI 3) | revised: 2 (MAI 3) | — |
| 37255 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37257 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37259 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37261 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37262 | CPT code (descriptor licensed by AMA) | revised: 4 (MAI 3) | revised: 4 (MAI 3) | — |
| 37264 | CPT code (descriptor licensed by AMA) | revised: 2 (MAI 3) | revised: 2 (MAI 3) | — |
| 37266 | CPT code (descriptor licensed by AMA) | revised: 2 (MAI 3) | revised: 2 (MAI 3) | — |
| 37268 | CPT code (descriptor licensed by AMA) | revised: 2 (MAI 3) | revised: 2 (MAI 3) | — |
| 37270 | CPT code (descriptor licensed by AMA) | revised: 2 (MAI 3) | revised: 2 (MAI 3) | — |
| 37272 | CPT code (descriptor licensed by AMA) | revised: 2 (MAI 3) | revised: 2 (MAI 3) | — |
| 37274 | CPT code (descriptor licensed by AMA) | revised: 2 (MAI 3) | revised: 2 (MAI 3) | — |
| 37276 | CPT code (descriptor licensed by AMA) | revised: 2 (MAI 3) | revised: 2 (MAI 3) | — |
| 37278 | CPT code (descriptor licensed by AMA) | revised: 2 (MAI 3) | revised: 2 (MAI 3) | — |
| 37279 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37281 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37283 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37285 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37287 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37289 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37291 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37293 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37295 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 37297 | CPT code (descriptor licensed by AMA) | revised: 2 (MAI 3) | revised: 2 (MAI 3) | — |
| 37299 | CPT code (descriptor licensed by AMA) | revised: 2 (MAI 3) | revised: 2 (MAI 3) | — |
| 87494 | CPT code (descriptor licensed by AMA) | revised: 3 (MAI 3) | revised: 3 (MAI 3) | — |
| 96127 | CPT code (descriptor licensed by AMA) | revised: 4 (MAI 3) | revised: 4 (MAI 3) | — |
| C9610 | Catheter, transluminal drug delivery with or without angioplasty, coronary, non-laser (insertable) | — | revised: 4 (MAI 3) | — |
| J2326 | Injection, nusinersen, 0.1 mg | revised: 500 (MAI 3) | revised: 500 (MAI 3) | — |
| J7172 | Injection, marstacimab-hncq, 0.5 mg | revised: 2400 (MAI 3) | revised: 2400 (MAI 3) | — |
| J7521 | Tacrolimus, granules, oral suspension, 0.1 mg | — | — | revised: 2160 (MAI 3) |
| J9329 | Injection, tislelizumab-jsgr, 1mg | revised: 400 (MAI 3) | revised: 400 (MAI 3) | revised: 400 (MAI 3) |
| J9380 | Injection, teclistamab-cqyv, 0.5 mg | revised: 918 (MAI 3) | revised: 918 (MAI 3) | revised: 918 (MAI 3) |
| 0552U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 3) | added: 1 (MAI 3) | — |
| 0553U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 3) | added: 1 (MAI 3) | — |
| 0554U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 3) | added: 1 (MAI 3) | — |
| 0555U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 3) | added: 1 (MAI 3) | — |
| 0558U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| 0559U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| 0560U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 3) | added: 1 (MAI 3) | — |
| 0561U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 3) | added: 1 (MAI 3) | — |
| 0562U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| 0563U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 3) | added: 1 (MAI 3) | — |
| 0564U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 3) | added: 1 (MAI 3) | — |
| 0565U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| 0566U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| 0567U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 3) | added: 1 (MAI 3) | — |
| 0568U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| 0569U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| 0570U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| 0571U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| 0572U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| 0573U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 3) | added: 1 (MAI 3) | — |
| 0574U | PLA code (descriptor licensed by AMA) | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| 0585U | PLA code (descriptor licensed by AMA) | deleted: 1 | deleted: 1 | — |
| A4288 | Valve for breast pump, replacement | — | — | added: 1 (MAI 3) |
| C1740 | Leadless electrode, transmitter, battery (all implantable), for sequential left ventricular pacing | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| C1742 | Pressure monitoring system, compartmental intramuscular (implantable), continuous, including all components (e.g., introducer, sensor), excludes mobile (wireless) software application | added: 1 (MAI 3) | added: 1 (MAI 3) | — |
| C8006 | Insertion of pleural-peritoneal shunt with intercostal pump chamber, including imaging, injection(s) of contrast with radiological supervision and interpretation, when performed | added: 1 (MAI 3) | added: 1 (MAI 3) | — |
| E0150 | Combination wheeled walker with seat and transport chair, folding, adjustable or fixed height | — | — | added: 1 (MAI 2) |
| E0658 | Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full arms and chest | — | — | added: 1 (MAI 2) |
| E0659 | Segmental pneumatic appliance for use with pneumatic compressor, integrated, head, neck and chest | — | — | added: 1 (MAI 2) |
| J0013 | Esketamine, nasal spray, 1 mg | added: 84 (MAI 3) | added: 84 (MAI 3) | — |
| J0162 | Injection, epinephrine (fresenius), not therapeutically equivalent to j0165, 0.1 mg | added: 20 (MAI 3) | added: 120 (MAI 3) | added: 0 (MAI 3) |
| J0654 | Injection, liothyronine, 1 mcg | added: 100 (MAI 3) | added: 100 (MAI 3) | added: 100 (MAI 3) |
| J1073 | Testosterone pellet, implant, 75 mg | added: 6 (MAI 3) | added: 6 (MAI 3) | — |
| J1736 | Injection, meloxicam (delova), 1 mg | added: 30 (MAI 3) | added: 30 (MAI 3) | added: 30 (MAI 3) |
| J1737 | Injection, meloxicam (azurity), 1 mg | added: 30 (MAI 3) | added: 30 (MAI 3) | added: 30 (MAI 3) |
| J1837 | Injection, posaconazole, 1 mg | added: 600 (MAI 3) | added: 600 (MAI 3) | added: 600 (MAI 3) |
| J2516 | Injection, pentamidine isethionate, 1 mg | added: 600 (MAI 3) | added: 600 (MAI 3) | added: 600 (MAI 3) |
| J2596 | Injection, vasopressin (long grove), not therapeutically equivalent to j2598, 1 unit | added: 160 (MAI 3) | added: 160 (MAI 3) | added: 160 (MAI 3) |
| J2598 | Injection, vasopressin, 1 unit | added: 160 (MAI 3) | added: 160 (MAI 3) | added: 160 (MAI 3) |
| J2599 | Injection, vasopressin (american regent), not therapeutically equivalent to j2598, 1 unit | added: 160 (MAI 3) | added: 160 (MAI 3) | added: 160 (MAI 3) |
| J2711 | Injection, neostigmine methylsulfate 0.1 mg and glycopyrrolate 0.02 mg | added: 60 (MAI 3) | added: 60 (MAI 3) | added: 60 (MAI 3) |
| J3291 | Injection, tranexamic acid in sodium chloride, 5 mg | added: 1600 (MAI 3) | added: 1600 (MAI 3) | added: 1600 (MAI 3) |
| J3376 | Injection, vancomycin hcl (hikma), not therapeutically equivalent to j3373, 10 mg | added: 600 (MAI 3) | added: 600 (MAI 3) | added: 600 (MAI 3) |
| J3379 | Injection, valproate sodium, 5 mg | added: 2000 (MAI 3) | added: 2000 (MAI 3) | added: 2000 (MAI 3) |
| J3387 | Injection, elivaldogene autotemcel, per treatment | added: 1 (MAI 2) | added: 1 (MAI 2) | added: 1 (MAI 2) |
| J7299 | Intrauterine copper contraceptive (miudella) | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| J7528 | Mycophenolate mofetil, for suspension, oral, 100 mg | added: 30 (MAI 3) | added: 30 (MAI 3) | added: 2700 (MAI 3) |
| J9184 | Injection, gemcitabine hydrochloride (avyxa), 200 mg | added: 19 (MAI 3) | added: 19 (MAI 3) | added: 19 (MAI 3) |
| J9256 | Injection, nipocalimab-aahu, 3 mg | added: 1500 (MAI 3) | added: 1500 (MAI 3) | added: 1500 (MAI 3) |
| J9282 | Mitomycin, intravesical instillation, 1 mg | added: 80 (MAI 3) | added: 80 (MAI 3) | — |
| J9326 | Injection, telisotuzumab vedotin-tllv, 1 mg | added: 200 (MAI 3) | added: 200 (MAI 3) | — |
| L1007 | Scoliosis orthosis, sagittal-coronal control provided by a rigid lateral frame, extends from axilla, to trochanter, includes all accessory pads, straps, and interface, custom fabricated | — | — | added: 1 (MAI 2) |
| L5657 | Addition to lower extremity prosthesis, manual/automated adjustable air, fluid, gel or equal socket insert for limb volume management, any materials | — | — | added: 2 (MAI 2) |
| L6034 | Partial hand, finger, and thumb prosthesis without prosthetic digit(s)/thumb, amputation at distal to metacarpal joint, including flexible or non-flexible interface, molded to patient model, for use without external power and/or passive prosthetic digit/thumb, not including inserts described by l6692 | — | — | added: 2 (MAI 2) |
| L6035 | Single prosthetic digit, mechanical, can include metacarpophalangeal (mcp), proximal interphalangeal (pip), and/or distal interphalangeal (dip) joint(s), with or without locking mechanism, can include flexion or extension assist, any material, attachment, initial issue or replacement | — | — | added: 1 (MAI 3) |
| L6036 | Prosthetic thumb, mechanical, can include metacarpophalangeal (mcp), interphalangeal (ip) joint(s), with or without locking mechanism, can include flexion or extension assist, any material, attachment, initial issue or replacement | — | — | added: 2 (MAI 2) |
| L6038 | Addition to single prosthetic digit or thumb, mechanical, attachment, multiaxial and/or internal/external rotation/abduction/adduction mechanism, with or without locking feature, any material | — | — | added: 1 (MAI 3) |
| L6039 | Passive prosthetic digit or thumb prosthesis not including hand restoration partial hand, full or partial, custom made, any material, initial or replacement, per single passive prosthetic digit or thumb | — | — | added: 1 (MAI 3) |
| M0235 | Intravenous infusion, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, not otherwise classified, first dose | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| M0236 | Intravenous infusion, monoclonal antibody products with an indication for post-exposure prophylaxis or treatment of covid-19, for hospitalized adults and/or pediatric patients who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, not otherwise classified, second dose | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| M0237 | Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, first dose | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| M0238 | Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose | added: 1 (MAI 2) | added: 1 (MAI 2) | — |
| Q5160 | Injection, bevacizumab-nwgd (jobevne), biosimilar, 10 mg | added: 230 (MAI 3) | added: 230 (MAI 3) | added: 230 (MAI 3) |
Pairs by effective quarter, January 2025 to October 2026
The full v323r0 files keep every pair CMS has ever published, with its effective and deletion dates. Counting rows by the quarter their effective date falls in, and by the quarter in which a deleted row stopped applying, shows how unevenly the edits grow: some quarters add tens of thousands of rows, others a few dozen.
| Quarter | Practitioner rows taking effect | Practitioner | Hospital | Practitioner end-dated | Hospital end-dated |
|---|---|---|---|---|---|
| January 2025 | 4,808 | 4,586 | 9,039 | 7,800 | |
| April 2025 | 38,656 | 38,276 | 127 | 257 | |
| July 2025 | 29,077 | 31,425 | 54 | 54 | |
| October 2025 | 1,880 | 1,832 | 261 | 320 | |
| January 2026 | 57 | 55 | 16,199 | 12,725 | |
| April 2026 | 3,768 | 3,714 | 5 | 5 | |
| July 2026 | 2,201 | 2,179 | 705 | 701 | |
| October 2026 | 4,256 | 4,153 | 21 | 21 |
Medicaid NCCI in the same quarter
Medicaid runs its own NCCI tables, published by CMS for state Medicaid programs. The 2026 Q4 Medicaid change report added 4,249 practitioner pairs, 4,249 of them identical to the Medicare additions, and 4,146 outpatient hospital pairs (4,146 shared with Medicare). It deleted 16 practitioner pairs against Medicare's 14, changed 7 modifier indicators, and touched the Medicaid DME table, which has no Medicare PTP counterpart (0 added, 2 deleted). Medicaid MUE additions were 62 practitioner, 62 outpatient hospital and 29 DME, against Medicare's 51, 51 and 29, so the Medicaid tables are not a copy of Medicare's.
What to do after this release
Confirm that the claim scrubber loaded the v323r0 tables on 2026-10-01; a scrubber still on the July tables lets the new pairs through and the claim denies at the contractor with CARC 97 or, for unit limits, CARC 151. Re-test the pairs that changed from modifier indicator 1 to 0 first, because modifier-based workarounds for them now fail.
For services that bill category III or PLA codes, review documentation and charge capture for the column-1 codes in the table above: each new pair is a service that can no longer be billed separately on the same date. The NCCI edits glossary entry explains column 1, column 2 and the modifier indicator, and the methodology behind these counts is on the reference methodology page.
Method
Additions, deletions and modifier-indicator changes come from the CMS quarterly change files for each setting; each pair is joined to the full v323r0 PTP file for its rationale, effective date and previous indicator. MUE changes come from the quarterly change files of the three MUE tables, joined to the full tables for the adjudication indicator. CPT codes appear as numbers only; pairs are published as per-code counts in the CSV, and only the deleted and re-flagged pairs are listed individually.
Part of the NCCI quarterly changes series, rebuilt from each CMS release. Next edition: January 2027 edition after the January 1, 2027 NCCI release. Earlier and later editions are listed on the research index.
Download the full table
The CSV holds the 2026 Q4 PTP additions summarized per column-1 code and setting, every deleted and re-flagged pair, and every MUE addition, deletion and revision: 1,449 rows, one header row and the columns setting, change, code or column1, column2, pairs, modifier allowed pairs, rationale, value or indicator change, mue adjudication indicator. Its first line is a comment that names each CMS source file with its SHA-256, the data date and the attribution line to keep when you reuse the table.
Table SHA-256 (the rows after the comment line): 58a093edb6f1420281e4db2ee8bdcfc29b5349108689bdc27c99f8cf8ddc2660. Data as of 2026-10-01.
Where QuickIntell fits after an NCCI release
A quarterly release changes which pairs and units a claim can carry. QuickCode supports qualified coder review, documentation clarification and the billing handoff, where pair edits, modifier support and units are settled on the whole claim.
Frequently asked questions
How many NCCI PTP edits did CMS add on October 1, 2026?
4,249 practitioner pairs across 604 column-1 codes and 4,146 hospital outpatient pairs. 4,146 pairs were added in both settings and 103 only in the practitioner table. CMS deleted 14 practitioner pairs and changed the modifier indicator or rationale of 7.
Why are most new edits on CPT category III codes?
2,728 of the practitioner additions have a category III code in column 1. Category III codes are the temporary CPT codes for emerging technology, services and procedures; 2,922 of the new pairs carry the rationale "misuse of column two code with column one code".
What does a modifier indicator of 0 or 1 mean on a new edit?
With indicator 1 an NCCI-associated modifier such as 59, XE, XS, XP or XU can bypass the edit when the documentation supports a distinct service; with indicator 0 the column-2 code is never paid with the column-1 code on the same date. 2,710 of the 4,249 new practitioner pairs allow a modifier.
What changed in the MUE tables?
In the practitioner table CMS added 51 codes, deleted 1 and revised 31; the outpatient hospital table changed by 51, 1 and 32, and the DME supplier table by 29, 0 and 3. The table below lists every code with its new value.
When is the next NCCI release?
CMS publishes the NCCI PTP and MUE tables quarterly, effective January 1, April 1, July 1 and October 1. The January 2027 edition of this report will follow the January 1, 2027 release.
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.
- 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 PTP quarterly changes, practitioner, 2026 Q4Version 2026 Q4 quarterly additions, deletions and revisions · effective 2026-10-01 · file medicare-ncci-2026q4-practitioner-quarterly-additions-deletions-revisions-ptp.zipSHA-256 fd9d7fac88ddbf76…
- NCCI PTP quarterly changes, hospital outpatient, 2026 Q4Version 2026 Q4 quarterly additions, deletions and revisions · effective 2026-10-01 · file medicare-ncci-2026q4-hospital-quarterly-additions-deletions-revisions-ptp.zipSHA-256 f950750d821b68ea…
- NCCI MUE quarterly changes, practitioner services, 2026 Q4Version 2026 Q4 quarterly additions, deletions and revisions · effective 2026-10-01 · file practitioner-services-mue-quarterly-additions-deletions-revisions-10012026.zipSHA-256 b8679f74e71e1f03…
- NCCI MUE quarterly changes, outpatient hospital services, 2026 Q4Version 2026 Q4 quarterly additions, deletions and revisions · effective 2026-10-01 · file outpatient-hospital-services-mue-quarterly-additions-deletions-revisions-10012026.zipSHA-256 0d9a389d3a5d3bcd…
- NCCI MUE quarterly changes, DME supplier services, 2026 Q4Version 2026 Q4 quarterly additions, deletions and revisions · effective 2026-10-01 · file durable-medical-services-mue-quarterly-additions-deletions-revisions-10012026.zipSHA-256 9d9495d7d3dc95de…
- Medicaid NCCI change report, effective 2026-10-01Version 2026 Q4 change report · effective 2026-10-01 · file medicaid-ncci-change-report-effective-10012026.zipSHA-256 5072331d137dc069…
- 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 MUE table, facility services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_OutpatientHospitalServices_Eff_10-01-2026.csvSHA-256 3af9f4e99cc587e2…
- NCCI MUE table, dme services, effective 2026-10-01Version 2026 Q4 · effective 2026-10-01 · file MCR_MUE_DMESupplierServices_Eff_10-01-2026.csvSHA-256 6fa4fbba852f7b74…
- HCPCS Level II alpha-numeric file, October 2026Version October 2026 · effective 2026-10-01 · file HCPC2026_OCT_ANWEB_09232026.txtSHA-256 c25240c63108756d…
Disclaimer
Counts describe the CMS files; payers that license NCCI may apply them on their own schedule. CPT codes appear as numbers only. Operational reference, 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.