CurrentFlorida BluePolicy 10-006

National Correct Coding Initiative (NCCI) Edits

This payment policy explains how Florida Blue applies CMS NCCI Procedure-to-Procedure (PTP) coding edits to professional and outpatient facility claims and which modifiers are recognized to bypass edits; it applies to all lines of business and providers billing on CMS-1500 (or equivalent) and UB-04 claim forms.

Policy Summary

PayerFlorida Blue

PolicyNational Correct Coding Initiative (NCCI) Edits

Policy CodePolicy 10-006

Change TypeMinor revision — no material clinical or coverage changes

Effective DateJul 10, 2025

Next Review Date

Key ActionDo not report both column-one and column-two codes of an NCCI PTP edit pair for the same provider, same member, same date of service unless an allowed modifier is correctly reported; column-two will be denied otherwise.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

professional & outpatientclaim types covered

column-two denieddefault edit result

25,59,XE,XS,XP,XU,+anatomicrecognized modifiers

CMS-1500 / UB-04billing forms

23-081related policy

NCCI Procedure-to-Procedure (PTP) Edit Application

NCCI PTP edit application rules

Florida Blue applies NCCI Procedure-to-Procedure (PTP) edits and will deny column-two codes unless allowed modifiers are correctly reported and the edit's modifier indicator permits bypass.

When a provider reports the two codes of an NCCI PTP edit pair for the same member on the same date of service, Florida Blue will deny the column-two code and allow the column-one code unless a recognized modifier is properly reported and the edit's modifier indicator permits bypass.

Each NCCI PTP edit has a modifier indicator: '0' means no modifier may be used to bypass the edit; '1' means a properly coded associated modifier can be used to allow the column-two service.

Florida Blue will not reimburse column-two codes separately unless the codes are correctly reported with one of the recognized modifiers and the edit's modifier indicator = 1.

ALL of the following

Policy Summary

PayerFlorida Blue

PolicyNational Correct Coding Initiative (NCCI) Edits

Policy CodePolicy 10-006

Change TypeMinor revision — no material clinical or coverage changes

Effective DateJul 10, 2025

Next Review Date

SourceLink

On This Page

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Billing Rules and What Providers Must Do

Billing Rule

Do not report both codes of an NCCI PTP pair without allowed modifier

Do not report both codes in an NCCI Procedure-to-Procedure (PTP) edit pair for the same provider, same member, same date of service; Florida Blue will deny the column-two code and allow column-one unless a recognized modifier that the edit’s modifier indicator permits is correctly reported. When the edit’s modifier indicator = 0, no modifier may bypass the edit; when = 1, a properly coded recognized modifier may bypass the edit.

Column-two code will be denied when both codes of an NCCI PTP pair are reported together unless a recognized modifier is properly reported and the edit’s modifier indicator permits bypass.
Modifier indicator = 0 means no modifier may bypass the edit; modifier indicator = 1 means a properly coded modifier can bypass the edit.
Recognized modifiers include anatomic modifiers (LT, RT, E1–E4, FA, F1–F9, TA, T1–T9, LC, LD, RC, LM, RI) and other modifiers (25, 59, XE, XS, XP, XU).

Key Terms and Recognized Modifiers

NCCI PTP edit — definition

DefinitionAn NCCI Procedure‑to‑Procedure (PTP) edit pairs two HCPCS/CPT codes (column‑one and column‑two) where the column‑two code is generally not separately reimbursable when reported with the column‑one code unless a recognized modifier is properly applied.

ApplicationFlorida Blue uses the column‑one/column‑two NCCI edits to determine whether codes reported together by the same provider for the same member on the same date of service are eligible for separate reimbursement.

Default resultIf both codes of an edit pair are reported, the column‑two code is denied and the column‑one code is eligible for payment unless a recognized modifier permits bypass under the edit's modifier indicator.

Recognized modifiers

Recognized general modifiers25, 59, XE, XS, XP, XU — may be used under appropriate clinical circumstances to bypass a PTP edit when the modifier indicator permits.

Examples of anatomic modifiersLT, RT, E1–E4, FA, F1–F9, TA, T1–T9, LC, LD, LM, RC, RI — anatomic modifiers listed by Florida Blue that may bypass edits when allowed.

Modifier coding requirementModifiers must be properly coded and associated with the submitted service; Florida Blue will not reimburse column‑two codes unless correctly reported with a recognized modifier and the edit's indicator allows it.

OpenPayer

National Correct Coding Initiative (NCCI) Edits

NCCI Procedure-to-Procedure (PTP) Edit Application

Edit Pairs, Modifiers, and Indicators

Billing Rules and What Providers Must Do

Key Terms and Recognized Modifiers

column-one	Allowed when paired — paid when both reported together unless modifier appropriately bypasses edit.
column-two	Denied by default when reported with the corresponding column-one code unless an allowed modifier is present.