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 v310r0 (450,012 Records) 0001A/0591T -- 24116/G0471 (ZIP) - Effective January 1, 2025; Posted December 2, 2024

Hospital PTP Edits v310r0 (450,023 Records) 24120/0213T -- 35903/G0471 (ZIP) - Effective January 1, 2025; Posted December 2, 2024

Hospital PTP Edits v310r0 (449,979 Records) 35905/0213T -- 61501/G0471 (ZIP) - Effective January 1, 2025; Posted December 2, 2024

Hospital PTP Edits v310r0 (437,236 Records) 61510/0082T -- U0003/U0004 (ZIP) - Effective January 1, 2025; Posted December 2, 2024

Practitioner PTP Edits

Practitioner PTP Edits v310r0 (645,134 Records) 0001A/0591T -- 25355/G0471 (ZIP) - Effective January 1, 2025; Posted December 2, 2024

Practitioner PTP Edits v310r0 (644,862 Records) 25360/01810 -- 36909/J2001 (ZIP) - Effective January 1, 2025; Posted December 2, 2024

Practitioner PTP Edits v310r0 (645,279 Records) 37140/0213T -- 61735/G0471 (ZIP) - Effective January 1, 2025; Posted December 2, 2024

Practitioner PTP Edits v310r0 (622,475 Records) 61736/0213T-- U0003/U0004 (ZIP) - Effective January 1, 2025; Posted December 2, 2024

2024 Quarter 4 Edit Files:

Hospital PTP Edits

• Hospital PTP Edits v303r0 (450,031 Records) 0001A/0591T -- 24200/G0471 (ZIP)- Effective October 1, 2024; Posted September 3, 2024
• Hospital PTP Edits v303r0 (450,043 Records) 24201/0213T -- 36253/G0471 (ZIP) - Effective October 1, 2024; Posted September 3, 2024
• Hospital PTP Edits v303r0 (450,019 Records) 36254/0213T -- 61536/G0471 (ZIP) - Effective October 1, 2024; Posted September 3, 2024
• Hospital PTP Edits v303r0 (432,569 Records) 61537/0213T -- U0003/U0004 (ZIP) - Effective October 1, 2024; Posted September 3, 2024

Practitioner PTP Edits

• Practitioner PTP Edits v303r0 (645,073 Records) 0001A/0591T -- 25420/G0471 (ZIP) - Effective October 1, 2024; Posted September 3, 2024
• Practitioner PTP Edits v303r0 (645,088 Records) 25425/01810 -- 37193/J2001 (ZIP) - Effective October 1, 2024; Posted September 3, 2024
• Practitioner PTP Edits v303r0 (644,997 Records) 37195/0213T -- 61850/G0471 (ZIP) - Effective October 1, 2024; Posted September 3, 2024
• Practitioner PTP Edits v303r0 (617,784 Records) 61855/61850-- U0003/U0004 (ZIP) - Effective October 1, 2024; Posted September 3, 2024