Prevent Improper Code Bundling With New Medicare Tool
By Alisa Pierce

Physicians can take advantage of a new Medicare tool to sort through the thousands upon thousands of service codes that can be bundled together for claims payment – and avoid improper billing. 

The Centers for Medicare & Medicaid Services (CMS) recently released the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) lookup tool to promote accurate code-bundling and prevent improper payment of Medicare Part B and Medicaid claims when incorrect code combinations are reported. The resource is meant to help ensure components of services made to the same patient, on the same date of service, by the same physician aren’t paid for twice. 

Available via Texas’ Medicare contractor Novitas Solutions, the tool is further designed to help physicians identify when certain pairs of codes are subject to automated edits.  

For more information, check out these resources:  

  • CMS publishes a quarterly updated list of codes on its website documenting the prohibited/acceptable code combination pairs.  
  • CMS also posts quarterly updates to PTP edits
  • Novitas Solutions has its own webpage on the NCCI initiative.  
  • The Texas Medical Association offers a comprehensive NCCI education sheet and other resources to help you submit claims accurately. 

Last Updated On

February 15, 2023

Originally Published On

February 15, 2023

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Alisa Pierce

Reporter, Division of Communications and Marketing

(512) 370-1469
Alisa Pierce

Alisa Pierce is a reporter for Texas Medicine. After graduating from Texas State University, she worked in local news, covering state politics, public health, and education. Alongside her news writing, Alisa covered up-and-coming artists in Central Texas and abroad as a music journalist. As a Texas native, she enjoys capturing the landscape on her film camera while hiking her way across the Lonestar State.

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