Primary tabs

Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS), previously known as the Health Care Financing Administration (HCFA), is a federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards.

Other Access

The information on this page (the dataset metadata) is also available in these formats.

JSON RDF

via the DKAN API

NCCI Procedure to Procedure Edits (PTP)

The CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B claims and Medicaid claims.

NCCI procedure-to-procedure (PTP) edits define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported.

Practitioner services also refers to ambulatory surgical centers.
DME refers to provider claims for durable medical equipment.

The CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B claims and Medicaid claims. NCCI procedure-to-procedure (PTP) edits define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported. The edits in this dataset are active for the dates indicated within. This file should NOT be used by state Medicaid programs as their edit file. Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein.

For more information, visit https://www.medicaid.gov/medicaid/program-integrity/ncci/index.html.

FieldValue
Publisher
Modified
2019-12-03
Release Date
2018-08-31
Homepage URL
Identifier
https://data.medicaid.gov/api/views/34v9-f8up
License
Contact Name
Medicaid.gov
Contact Email
Public Access Level
Public
Bureau Code
009:00 - Department of Health and Human Services
Program Code
009:076 - Department of Health and Human Services - Medicaid
Harvested from data.medicaid.gov
Harvest Source Titledata.medicaid.gov
Harvest Source URIhttps://data.medicaid.gov/data.json
Last Harvest PerformedThu, 12/12/2019 - 02:38
Uncategorized