CMS NCCI PTP Edits
Medically Unlikely Edits (MUE)
2026 Quarterly Release
CMS NCCI Edit Checker & Procedure Bundling Directory
Lookup official Centers for Medicare & Medicaid Services (CMS) National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edit pairs, Column 1 / Column 2 code relationships, and Modifier Indicator allowances (0, 1, 9) to prevent unbundling claim rejections.
High-Volume Procedure-to-Procedure (PTP) Edit Pairs
Common Column 1 (Comprehensive) and Column 2 (Component) procedure pairs governed by CMS quarterly bundling tables.
| Column 1 (Comprehensive) | Column 2 (Component/Bundled) | Modifier Indicator | Clinical Rationale / Override Rule |
|---|---|---|---|
| 43239 (EGD with Biopsy) | 43235 (Diagnostic EGD) | 0 (Not Allowed) | Diagnostic endoscopy is inherently included in surgical biopsy performed at same session. |
| 29881 (Knee Arthroscopy w/ Meniscectomy) | 29870 (Diagnostic Knee Arthroscopy) | 0 (Not Allowed) | Diagnostic scope is integral to therapeutic surgical procedure in same compartment. |
| 45380 (Colonoscopy with Biopsy) | 45378 (Diagnostic Colonoscopy) | 0 (Not Allowed) | Diagnostic colonoscopy merges into therapeutic biopsy; cannot unbundle. |
| 99214 (Office Visit E/M) | 17000 (Lesion Destruction) | 1 (Allowed) | Can unbundle with Modifier 25 if E/M is significant and separately identifiable. |
| 93000 (Routine ECG Complete) | 93010 (ECG Report/Interpretation) | 0 (Not Allowed) | Component interpretation is integral to complete global code 93000. |
| 36415 (Routine Venipuncture) | 80053 (CMP Blood Panel) | 1 (Allowed) | Allowed with Modifier 59 / XU if drawn at a completely separate encounter session. |
CMS Modifier Indicators & MUE Threshold Guide
Understanding CMS NCCI Modifier Indicators and Medically Unlikely Edit (MUE) maximum daily units per beneficiary.
| Modifier Indicator | Definition | Action Required |
|---|---|---|
| Indicator 0 | Not Allowed: NCCI edit pair cannot be bypassed under any circumstances. | Do not append Modifier 59/25. Column 2 code will be denied if billed together. |
| Indicator 1 | Allowed: NCCI edit pair may be bypassed with an appropriate modifier. | Append Modifier 25, 59, XE, XP, XS, or XU if services are distinct and documented. |
| Indicator 9 | Deleted / Inactive: The edit pair was deleted retrospectively by CMS. | No modifier required. Standard processing rules apply. |