The complete updated Medicaid National Correct Coding Initiative (NCCI) edit files are posted here at the beginning of each calendar quarter. These data replace the Medicaid NCCI edit files from previous calendar quarters. The presence of a HCPCS/CPT code in a Procedure-to-Procedure (PTP) edit or a Medically Unlikely Edits (MUEs) value for a HCPCS/CPT code does not necessarily indicate that the code is covered by any state Medicaid program or by all state Medicaid programs. States cannot use the files here for processing and paying Medicaid claims.
How to Access the Files
This page provides links to NCCI Edit data on Data.Medicaid.gov, where you can filter, sort, share, and download the data. To download data as an Excel file, first follow the links on this page to navigate to your dataset. Select the “Export” button in the top right of the data, then select “CSV for Excel” from the download list.
Note: Excel limits the number of rows that can be exported in a single CSV for Excel file to 1,048,576 rows. The Practitioner and Outpatient Hospital PTP edit files both contain significantly more rows than that. To download the complete Practitioner or Outpatient Hospital PTP edit file, we recommend using the Filter function to divide the complete file into two smaller files:
- Effective date between October 1, 2010 and March 31, 2013
- Effective date after March 31, 2013
Each file can then be exported in CSV for Excel. The Durable Medical Equipment PTP edit file and all three MUE files can be exported as single CSV for Excel files.
Complete Medicaid NCCI Edit Files for Calendar Quarter Beginning January 1, 2021
- 2021 Q1 NCCI PTP Edits - Practitioner Services posted December 3, 2020
- 2021 Q1 NCCI PTP Edits - Outpatient Hospital Services posted December 3, 2020
- 2021 Q1 NCCI PTP Edits - Durable Medical Equipment Services posted December 3, 2020
- 2021 Q1 NCCI MUE Edits - Practitioner Services updated December 15, 2020
- 2021 Q1 NCCI MUE Edits - Outpatient Hospital Services updated December 15, 2020
- 2021 Q1 NCCI MUE Edits - Durable Medical Equipment Services updated December 15, 2020
Complete Medicaid NCCI Edit Files for Calendar Quarter Beginning October 1, 2020
- 2020 Q4 NCCI PTP Edits - Practitioner Services posted September 4, 2020
- 2020 Q4 NCCI PTP Edits - Outpatient Hospital Services posted September 4, 2020
- 2020 Q4 NCCI PTP Edits - Durable Medical Equipment Services posted September 4, 2020
- 2020 Q4 NCCI MUE Edits - Practitioner Services posted September 4, 2020
- 2020 Q4 NCCI MUE Edits - Outpatient Hospital Services posted September 4, 2020
- 2020 Q4 NCCI MUE Edits - Durable Medical Equipment Services posted September 4, 2020
Medicaid Change Report Files
The Medicaid Change Report files contain only the changes made in the Medicaid NCCI edit files from the previous calendar quarter. Information on these files is contained in Change Report File Information (DOCX, 14.62 KB).
- Medicaid NCCI Replacement File Change Report (ZIP, 49.6 KB) (files for edits effective January 1, 2021) posted December 15, 2020
- Medicaid NCCI Change Report (ZIP, 2.21 MB) (files for edits effective January 1, 2021) posted December 3, 2020
- Medicaid NCCI Change Report (ZIP, 4.67 MB) (files for edits effective October 1, 2020) posted September 4, 2020