The Centers for Medicare & Medicaid Services (CMS) maintains the NCCI edits, which stand for National Correct Coding Initiative edits. These edits are automated rules that prevent improper payments from wrong coding combinations or other violations.<\/p>\n\n\n\n
They apply to every Medicare Part B claim before claims are adjudicated. NCCI edits evaluate whether HCPCS and CPT code combinations reported by the same provider for the same patient on the same date are correctly reported and clinically appropriate.<\/p>\n\n\n\n
If a claim violates NCCI edits, it may be adjusted or rejected before payment. Additionally, Medicaid programs in the U.S. must follow the NCCI methodologies (ACA Section 6507<\/a>), per CMS guidance.<\/p>\n\n\n\n These edits are updated quarterly and directly affect the first-pass resolution rate for practices billing Medicare and Medicaid. <\/p>\n\n\n\t\t\t\t