Using the NCCI Policy Manual for Medicare

The NCCI Policy Manual for Medicare is available as a reference tool for correct coding and to explain the rationale for NCCI edits. Each chapter corresponds to a separate section of the CPT Manual, except:

● Chapter 1 has general correct coding policies

● Chapter 12 discusses HCPCS Level 2 codes

● Chapter 13 discusses Category III CPT codes

Each chapter is subdivided by topic to allow easier access to a particular code or group of codes. The introduction or narrative of any chapter doesn’t override Medicare policy.

The Introduction and Chapter 1 of the manual are excellent resources for basic information about proper coding practices and coding edits. Chapter 1, General Correct Coding Policies, discusses general coding principles, issues, and policies. Later chapters discuss many of these principles, issues, and policies in more detail with specific groups of HCPCS/CPT codes.

The manual uses examples to clarify principles, issues, or policies. The principles, issues or policies can apply to other codes beyond those used in examples. It’s also recommended that you review the chapters of the manual that relate to the code ranges you bill most often. These chapters include detailed information about correct coding and using NCCI-associated modifiers for separately reportable services.

The NCCI Program updates the NCCI Policy Manual for Medicare annually. You can find the NCCI Policy Manual using the link in the left navigation menu on the NCCI Edits webpage.

Need More Information?

Because MACS handle NCCI edits as part of routine claim processing, send your claim-specific questions to the MAC. Find your MAC’s website. This includes appeals of your NCCI-related claim denials.

The NCCI contractor can answer questions and concerns about NCCI edits and the program in general. Email questions about the NCCI program, including those related to NCCI edits (PTP, MUE, and AOC) to NCCIPTPMUE@cms.hhs.gov.