What the tables contain
- Version
- v323r0 (2026 Q4)
- Effective
- 2026-10-01
- Practitioner pairs (active)
- 1732820
- 10,881 column-1 codes
- Hospital outpatient pairs (active)
- 1406699
- 10,011 column-1 codes
- Practitioner pairs with modifier allowed
- 70%
The National Correct Coding Initiative exists to stop payment for services that should not be reported together: a component that is part of a more comprehensive procedure, two codes that describe mutually exclusive ways of doing the same thing, or a service that is standard preparation or monitoring for another. CMS publishes the pairs quarterly as column-1 and column-2 code tables with a modifier indicator and a rationale, one table for practitioner claims and one for hospital outpatient claims processed through the Integrated Outpatient Code Editor. The pairs are directional: the column-1 code is the one that is paid, and reporting the column-2 code on the same date of service denies it as bundled. The rationales in the current file are 12 fixed categories, of which misuse of the column-2 code with the column-1 code, coding-manual instructions and standards of medical and surgical practice account for most pairs.
Modifiers that can separate a pair
A modifier only bypasses the edit when the record shows a separate session, site, practitioner, incision or injury; appending 59 to force payment is the fastest route to a post-payment review.
| Modifier | When it applies |
|---|---|
| 59 | Distinct procedural service, when no more specific X modifier applies |
| XE | Separate encounter on the same date |
| XS | Separate organ or structure |
| XP | Separate practitioner |
| XU | Unusual, non-overlapping service |
| 25 | Significant, separately identifiable E/M service on the day of a procedure |
| 57 | E/M decision for surgery on the day of or before a major procedure |
| E1 to E4, FA to F9, TA to T9, LT, RT | Anatomic modifiers that show different sites |
| 24, 27, 58, 78, 79, 91 | Global-period and repeat-service modifiers CMS lists as NCCI-associated |
Since 2015 CMS has asked for the X modifiers in place of 59 whenever one of them fits, because they say why the service was distinct instead of merely asserting it. Modifier 25 is used on the evaluation and management code, not on the procedure, when the visit was significant and separately identifiable; the pair edit between an E/M code and a minor procedure is what that modifier exists to address. None of the modifiers works on a pair with indicator 0, and none makes an unbundled service medically necessary; the coverage policies still decide that.
Using the checker in a billing workflow
Run the pair before the claim goes out whenever two procedure codes share a date of service, and again when a denial arrives. A bundled result with indicator 1 means the claim can carry an NCCI-associated modifier if the documentation supports a distinct service; a bundled result with indicator 0 means the column-2 code should be removed and the column-1 code billed alone, because no modifier will be honoured and the appeal has no basis in the edit. A pair that is not bundled can still deny for units, which the MUE lookup answers, or for an add-on code reported without its primary, or under a payer's own bundling policy, since Medicare Advantage plans and commercial payers run their own edit sets that start from NCCI but do not end there. State Medicaid programmes apply a separate Medicaid NCCI table that differs in places from the Medicare one. On the remittance, NCCI bundling appears as CARC 97 with remark M15, or as reason code 236; the denial pages cover the appeal.
The checker answers one pair at a time from a packed copy of the CMS tables on the server; it does not list every partner of a code, because that list is the CMS file itself and belongs in an encoder. The per-code exposure, meaning how many pairs name a drug code as column 2 and what share allow a modifier, is on each HCPCS drug code page, and the methodology page records the file versions and hashes behind every number.
Frequently asked questions
What is an NCCI procedure-to-procedure edit?
A PTP edit is a pair of HCPCS or CPT codes that CMS will not pay together for the same patient on the same date of service by the same provider. The column-1 code is paid and the column-2 code denies as bundled, unless the pair carries modifier indicator 1 and a documented NCCI-associated modifier is appended.
What do modifier indicators 0, 1 and 9 mean?
Indicator 0 means no modifier can separate the pair; the column-2 code is never paid with the column-1 code. Indicator 1 means an NCCI-associated modifier such as 59, XE, XS, XP, XU, 25 or an anatomic modifier bypasses the edit when the record supports a distinct service. Indicator 9 marks edits that were deleted retroactively and are not applied.
Why are there separate practitioner and hospital tables?
CMS publishes one PTP table for practitioner claims processed under the Physician Fee Schedule and another, applied through the Integrated Outpatient Code Editor, for hospital outpatient facility claims. Most pairs appear in both, but the hospital table omits edits that do not apply to facility billing and adds a few of its own, so the checker asks which claim you are testing.
How current is this checker?
It uses the 2026 Q4 practitioner and hospital PTP tables, version v323r0, effective October 1, 2026, and only pairs without a deletion date. CMS updates the tables quarterly; the January 2027 release replaces this one.
Why are the code descriptions missing?
CPT descriptors are copyrighted by the American Medical Association and QuickIntell does not hold a distribution license for public display. The checker shows bare code numbers; HCPCS Level II descriptors are public and appear on the HCPCS drug code pages.
Which denial codes does an NCCI edit produce?
The remittance usually carries claim adjustment reason code 97 (the benefit for this service is included in the payment for another service) with remark M15, or reason code 236 (this procedure is not compatible with another procedure provided on the same day according to NCCI). The denial pages for both explain the appeal path.
Sources
Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-02. Verify against the primary file before billing or contracting decisions.
- NCCI PTP edits, practitioner, v323r0 (four files)Version v323r0 (2026 Q4) · effective 2026-10-01 · file ccipra-v323r0-f1.TXTSHA-256 7793c0b6686c1e22…
Disclaimer
Operational reference compiled from the CMS NCCI quarterly files. Payment also depends on documentation, the payer's own edits and coverage policy. CPT codes appear as bare numbers. Not legal, clinical or billing advice.