NCCI Edit & Modifier-Bypass Checker
NCCI Procedure-to-Procedure edit check: whether a code pair can be reported together, and by the modifier indicator whether an NCCI-associated modifier may bypass the edit.
Open the tool → Runs in your browser. Data leaves only if you deliberately send a problem report from the interactive tool.
Example
- Code A
- 11042
- Code B
- 97597
- Which code is column 1 of the PTP pair
- Code A is Column 1 (B bundles into A)
- PTP modifier indicator
- 1
- Proposed modifier, e.g. 59 or XS
- 59
Result: Indicator 1: 59 is an NCCI-associated modifier; it may bypass the edit with supporting documentation. (Illustrative pair -- confirm the indicator in the CMS PTP file.)
The tool opens with these values already filled in. Replace them with your own.
What you enter
- Code A (HCPCS/CPT)
- Code B (HCPCS/CPT)
- Which code is column 1 of the PTP pair
- PTP modifier indicator (0 never bypass, 1 may bypass, 9 not applicable)
- Proposed modifier, e.g. 59 or XS
How this is calculated
CMS National Correct Coding Initiative (NCCI) Policy Manual, Ch. I; Pub. 100-04 Ch. 23. PTP modifier indicator: 0 = no modifier permitted; 1 = a permitted NCCI-associated modifier may bypass; 9 = edit deleted/not active. No PTP edit file ships -- the indicator is entered. Read the source ↗
A reference and educational tool. Not medical, legal, or financial advice, and not a substitute for clinician judgment.
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