Medicaid NCCI Methodologies
Medicaid NCCI Methodologies
The Medicaid National Correct Coding Initiative (NCCI) program consists of six methodologies:
Procedure-to-Procedure (PTP) edits for practitioner and ambulatory surgical center (ASC) services
PTP edits for outpatient services in hospitals (including emergency department, observation, and hospital laboratory services)
PTP edits for durable medical equipment
Medically Unlikely Edits (MUEs) for practitioner and ASC services
MUEs for outpatient services in hospitals
MUEs for durable medical equipment
Each of the Medicaid NCCI methodologies has four components:
A set of edits
Definitions of claim types subject to the edits
A set of claim adjudication rules for applying the edits, found in appendices B and C of the Medicaid NCCI Technical Guidance Manual (PDF)
Information on claims denials based on the NCCI edits, found in the State Medicaid Director Letter #11-003 (PDF)
The Medicaid NCCI methodologies apply only to Medicaid fee-for-service claims that are reimbursed based on the Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes.
Page Last Modified:
09/10/2024 06:01 PM