Coding edits
NCCI edits lookup: PTP, MUE and add-on code edits
Check a code or a code pair against the National Correct Coding Initiative edits before the claim goes out. RCIntel covers all three edit types, PTP, MUE and AOC, for practitioner, hospital outpatient and DME venues, and every answer links back to the CMS file it came from.
Use it in the browser, or call it from your own software over REST or MCP.
The three NCCI edit types
PTP edits
Procedure-to-procedure pairs. Two codes billed for the same patient, provider and date of service where CMS treats one as part of the other. Each pair carries a modifier indicator that says whether a modifier can separate them.
Practitioner and hospital outpatientMUE limits
Medically unlikely edits. The most units of a code CMS expects one provider to bill for one patient on one date of service. Each limit carries an adjudication indicator and a rationale.
Practitioner, hospital outpatient and DMEAdd-on code edits
AOC edits. An add-on code is only payable alongside a listed primary code. The edit lists the eligible primaries for each add-on.
Medicare add-on code fileWorked example: colonoscopy with polypectomy
A practitioner bills 45385 (colonoscopy with removal of polyp by snare) and 45378 (diagnostic colonoscopy) on the same date of service. The pair is a PTP edit with 45385 in column 1 and 45378 in column 2. The diagnostic colonoscopy is part of the polypectomy, so 45378 is bundled.
- Column 1 / Column 2
- 45385 / 45378
- Modifier indicator
- 0: modifier not allowed
- Rationale
- CPT separate procedure definition
- In effect since
- January 1, 1996
The indicator is 0, so no modifier, including 59 or XS, unbundles the pair. Bill 45385 alone; if both go out, 45378 denies.
curl "https://api.your-domain.com/v1/ncci/ptp/prac?col1_proc_cd=45385&col2_proc_cd=45378" \
-H "X-API-Key: $RCINTEL_API_KEY"Source: CMS Medicare NCCI PTP edits, practitioner file. NCCI files update every quarter; look up the date of service you are billing for the edit in effect on that date.
From your own software
The call above checks one PTP pair. MUE and add-on code lookups, and the request and response schemas for each, are in the API reference. The same lookups are available to AI agents over MCP.
Where NCCI edits fit
NCCI edits are one of the checks in claim review. See how teams use them before submission and when resolving denials, or talk to us about your workflow.
Edits reflect the public CMS NCCI files and are provided for reference. Confirm against the current CMS release before billing.