Nebraska Medicaid Program

National Correct Coding Initiative (NCCI)

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The Center for Medicare and Medicaid Services (CMS) requires that state Medicaid programs implement the methodologies of the National Correct Coding Initiative (NCCI). CMS originally developed the NCCI methodologies in 1996 to promote national correct coding methodologies and to control improper coding leading to inappropriate payments of Medicare claims.

The coding policies were developed based on coding conventions defined in the American Medical Association's Current Procedural Terminology (CPT) manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The CMS reviews and updates these policies annually.

The CMS has reviewed these coding policies and determined that all of the NCCI coding methodologies are appropriate for Medicaid claims. The policies, Medicaid specific NCCI manuals, and additional information can be found at the CMS website)(http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/National-Correct-Coding-Initiative.html).

The NCCI edits are effective for claims received on or after April 1, 2011, for service dates beginning 10/1/2010. Compliance with the edits may be determined prospectively (pre-payment editing that results in a claim denial) or retrospectively (post-payment editing that results in a refund request).

The CMS has directed states to apply the NCCI edits first and similar state edits second. So adjusting a claim to comply with NCCI may not result in payment if the claim remains out of compliance with Nebraska specific edits.

Nebraska Medicaid had a sample of claims compared to the NCCI edits and found that most claims are compliant with the CMS expectations. Nebraska Medicaid will continue to publish updates and informational materials as they become available. If you have questions, please contact Lea Clauss via e-mail at Lea.Clauss@nebraska.gov or via phone at (402)471-1019.

PDF Frequently Asked Questions

Links

NCCI Provider Information

Please go to the Center for Medicare and Medicaid Services website for the NCCI Coding Policy Manuals, the NCCI (procedure to procedure and MUE) edits, and additional information.

PDF Provider Bulletins

​13-68 New National Correct Coding Initiative (NCCI) Edits Regarding Evaluation-and-Management Services on the Day of Surgery, Effective October 2013 ​10/8/13
12-55 National Correct Coding Initiative (NCCI) Retrospective Claims Editing ​11/5/12
11-63 National Correct Coding Initiative (NCCI) Denials, Adjustments, & Appeals 10/21/11
​11-62 Using MCCS to Check Claim Status ​10/21/11
​11-61 Billing for Multiple Services on the Same Service Date ​10/21/11
​11-60 CPT Procedure Code 99082 (Unusual Travel) ​10/21/11
​11-59 Procedure Code Modifiers & NCCI ​10/21/11
​11-58 Laboratory Services and the National Correct Coding Initiative (NCCI) ​10/21/11
​11-57 Procedure Code Modifier 59 and Physical or Occupational Therapy Claims ​10/21/11
​11-51 Medicaid Prior Authorization: Enzyme-Replacement Therapy (ERT) for Lysosomal Storage Disorders ​09/20/11
11-50 Billing for Physician Administered Medications on the Same Date as an Office Visit 09/20/11
11-48 Room Charge Billing for Observation Room and Emergency Department Services 08/30/11
11-47 Billing for Durable Medical Equipment & Supplies with the National Correct Coding Initiative 08/30/11
11-46 Medicaid Coverage of Speech Therapy 08/30/11
11-42 Billing for Allergy Code Injections (Codes 95115 and 95117) 08/04/11
11-23 Claims for MHSA Services & the National Correct Coding Initiative 06/17/11
11-22 Medicaid Coverage of Physical & Occupational Therapy 05/09/11
11-21 Medicaid Coverage of Speech Therapy Procedure Codes 92506, 92507, and 92508 04/01/11
11-20 The National Correct Coding Initiative 03/15/11
11-13 UPDATE Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits 02/11/11
10-39 Nebraska Medicaid Implementation of the National Correct Coding Initiative Edits 09/20/10

DHHS Contact: Lea Clauss (402)471-1019 Lea.Clauss@nebraska.gov


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