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
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
2024 Quarter 3 Edit Files:
Hospital PTP Edits
- Hospital PTP Edits v302r0 (445,133 Records) 0001A/0591T -- 24305/G0471 (ZIP) - Effective July 1, 2024; Posted June 3, 2024
- Hospital PTP Edits v302r0 (444,952 Records) 24310/0213T -- 35907/G0471 (ZIP) - Effective July 1, 2024; Posted June 3, 2024
- Hospital PTP Edits v302r0 (445,089 Records) 36000/0213T -- 61321/G0471 (ZIP) - Effective July 1, 2024; Posted June 3, 2024
- Hospital PTP Edits v302r0 (440,644 Records) 61322/0213T -- U0003/U0004 (ZIP) - Effective July 1, 2024; Posted June 3, 2024
Practitioner PTP Edits
- Practitioner PTP Edits v302r0 (645,106 Records) 0001A/0591T -- 25492/G0471 (ZIP) - Effective July 1, 2024; Posted June 3, 2024
- Practitioner PTP Edits v302r0 (645,145 Records) 25500/01810 -- 37220/J2001 (ZIP) - Effective July 1, 2024; Posted June 3, 2024
- Practitioner PTP Edits v302r0 (644,908 Records) 37221/0078T -- 62121/G0471 (ZIP) - Effective July 1, 2024; Posted June 3, 2024
- Practitioner PTP Edits v302r0 (610,801 Records) 62140/0213T-- U0003/U0004 (ZIP) - Effective July 1, 2024; Posted June 3, 2024
