NCCI Resources

On June 5, 2009, in Documents, by AQ-IQ LLC

CMS originally developed the Medically Unlikely Edit (MUE) program to reduce the paid claims error rate for Part B claims. The first edits were implemented January 1, 2007. Subsequently there have been quarterly updates increasing the number of edits. In 2008, CMS has been refining the edits based on 100% submitted claims data from a six month period in 2006. For a complete overview, visit the MUE Main page at CMS website.

NOTICE:  For the first quarter of 2015, additional hospital and physician NCCI edit files have been provided which contain an edit rationale column.   These files, labeled as “NTIS format” are formatted to match the files previously supplied by NTIS.  For the January, 2015 release the structure of the current NCCI edit data files will remain unchanged and both versions will be posted.  However, these two files structures will be consolidated into a single format for future releases.

Important notice to all NCCI Users concerning the National Correct Coding Initiative Policy Manual for Medicare Services:

The annual updated version of the National Correct Coding Initiative Policy Manual for Medicare Services will be effective January 1, 2015.  Additions/revisions to the manual have been italicized in red font.

Quarterly updates are posted here.

Find CMS’s MUE FAQs HERE.


FREE Downloads from CMS

Hospital CCI Edits v21.0 effective January 1, 2015 (652,763 records). The last row contains edit column 1 = 39599 and column 2 = 49570.

Hospital CCI Edits v21.0 effective January 1, 2015 (542,794 records). The first row contains edit column 1 = 40490 and column 2 = C8950.

NTIS Format – Hospital CCI Edits v21.0 effective January 1, 2015. The last row of file 1 contains edit column 1 = 39599 and column 2 = 49570 (652,763 records). The first row of file 2 contains edit column 1 = 40490 and column 2 = C8950 (542,794 records).

Physician CCI Edits v21.0 effective January 1, 2015 (898,800 records). The last row contains edit column 1 = 39599 and column 2 = 49570.

Physician CCI Edits v21.0 effective January 1, 2015 (787,357 records). The first row contains edit column 1 = 40490 and column 2 = C8950.

NTIS Format – Physician CCI Edits v21.0 effective January 1, 2015. The last row of file 1 contains edit column 1 = 39599 and column 2 = 49570 (898,800 records). The first row of file 2 contains edit column 1 = 40490 and column 2 = C8950 (787,357 records).

Hospital CCI Edits v18.1 – Effective 4/1/12
Physician CCI Edits v18.1 – Effective 4/1/12
Hospital Outpatient Services MUE Table – Updated 4/1/09
(ZIPPED Excel file, 92 KB)


more useful links for providers below:
How to Use The National Correct Coding Initiative (NCCI) Tools [PDF, 2MB]

Medicare Claim Review Programs Booklet on MR, NCCI Edits, MUEs, CERT, and RAC (PDF, 14 pgs, 1.73 MB)

MLN Matters Number: MM5402 – Medically Unlikely Edits (MUEs) Announcement, January 2, 2007 (PDF, 2 pgs, 78 KB)

Letter Announcing Publication of MUEs, dated September 18, 2008 (PDF, 2 pgs, 51 KB)

Transmittal 1386: Quarterly Update to CCI Edits, Version 14.0, Effective 01/01/2008 (also referred to as Change Request 5824) (PDF, 5 pgs, 154 KB)

MLN Matters Number: MM5824 – Qtrly Update, v14.0, Effective 01/01/2008 (PDF, 2 pgs, 72 KB)

NCCI Policy Manual for Medicare Services – Effective 1/1/2015 (zip file of 15 documents)
NCCI Policy Manual for Medicare Services – Effective 1/1/2014 (zip file of 15 documents)

NCCI Policy Manual for Medicare Services – Updated 10/1/10 (PDF as ZIP file, 551kb)
NCCI Policy Manual for Medicare Services – Updated 4/9/09 (PDF as ZIP file, 444 KB)

Chapter 23 – Fee Schedule Administration and Coding Requirements [PDF, 1MB]

Correspondence Language Manual for Medicare Services – Effective April 1, 2014 [PDF, 197KB]

Modifier 59 Article: Proper Usage Regarding Distinct Procedural Service – Updated 10/28/14 [PDF, 130KB]

Medicaid NCCI File Names and Formats

 

 

 

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