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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.4 Claims Filing Instructions : 6.4.1 National Correct Coding Initiative (NCCI) Guidelines : 6.4.1.1 NCCI Processing Categories

6.4.1.1
The following coding rule categories are applied to claims that are submitted with dates of service on or after October 1, 2010:
 
CMS has assigned to all procedure codes a maximum number of units that may be submitted for a client per day, regardless of the provider. The maximum number of units for each procedure code is based on the following criteria:
Important:
If the maximum number of units has been exceeded on a particular line item, the line item will be denied. The line item will not be cut back to the allowable quantity. The line item may be appealed with the appropriate quantity for consideration
NCCI is a collection of bundling edits created and sponsored by CMS that are separated into two major categories: Column I and Column II procedure code edits (previously referred to as “Comprehensive” and “Component”) and Mutually Exclusive procedure code edits.
NCCI edits are applied to services that are performed by the same provider on the same date of service only and do not apply to services that are performed within the global surgical period. Each NCCI code pair edit is associated with a policy as defined in the National Correct Coding Initiative Policy Manual. Effective dates apply to code pairs in NCCI and represent the date when CMS added the code pair combination to the NCCI edits. Code combinations are processed based on this effective date. Termination dates also apply to code pairs in NCCI. This date represents the date when CMS removed the code pair combination from the NCCI edits. Code combinations are refreshed quarterly.

Texas Medicaid & Healthcare Partnership
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