CMS has developed coding edits in order to prevent improper payments. There are three different types of edits.
- Procedure to Procedure (PTP) edits prevent improper payment when incorrect code combinations are reported.
- Medically Unlikely Edits (MUE) are to prevent improper payments when services are reported with incorrect units of service.
- Add-on Code Edits list which primary codes may be used for each add-on code.
- Type I add-on codes have a limited number of specifically defined primary procedure codes (defined either by the CPT® book, HCPCS manual, and/or CMS policy)
- Type II codes do not have defined primary codes—each Medicare Administrative Contractor (MAC) creates its own list of primary codes
- Type III codes—some primary codes are specifically identified, but MACs may develop additional primary codes
To learn more about NCCI edits, please visit www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/PTP-Coding-Edits