Medicare NCCI Procedure to Procedure (PTP) Edits

National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits prevent inappropriate payment of services that should not be reported together. Each edit has a Column One and Column Two HCPCS/CPT code. If a provider reports the two codes of an edit pair for the same beneficiary on the same date of service, the Column One code is eligible for payment, but the Column Two code is denied unless a clinically appropriate NCCI PTP-associated modifier is also reported.

Quarterly Version Update Changes

CMS posts changes to each of its NCCI PTP published edit files on a quarterly basis. This includes additions, deletions, and modifier indicator quarterly changes to PTP column one/column two correct coding edits and the PTP mutually exclusive code edits for Practitioners and Hospital Outpatient PPS in the Outpatient Code Editor.

Related Downloads

2025 Quarter 1 Edit Files:

Hospital PTP Edits

Hospital PTP Edits v311r0 (475,136 Records) 0001A/0591T -- 24655/G0471 (ZIP) - Effective April 1, 2025; Posted March 5, 2025

Hospital PTP Edits v311r0 (475,072 Records) 24665/0213T -- 37203/C8952 (ZIP) - Effective April 1, 2025; Posted March 5, 2025

Hospital PTP Edits v311r0 (474,826 Records) 37204/0213T -- 62320/G0471 (ZIP) - Effective April 1, 2025; Posted March 5, 2025

Hospital PTP Edits v311r0 (400,490 Records) 62321/0178T -- U0003/U0004 (ZIP) - Effective April 1, 2025; Posted March 5, 2025

Practitioner PTP Edits

Practitioner PTP Edits v311r0 (675,242 Records) 0001A/0591T -- 25680/G0471 (ZIP) - Effective April 1, 2025; Posted March 5, 2025

Practitioner PTP Edits v311r0 (674,813 Records) 25685/01810 -- 38760/G0471 (ZIP) - Effective April 1, 2025; Posted March 5, 2025

Practitioner PTP Edits v311r0 (675,103 Records) 38765/0213T -- 63277/G0471 (ZIP) - Effective April 1, 2025; Posted March 5, 2025

Practitioner PTP Edits v311r0 (571,248 Records) 63278/0213T-- U0003/U0004 (ZIP) - Effective April 1, 2025; Posted March 5, 2025