CMS publishes 2025 Q3 update for NCCI edit files

CMS posted the third quarter National Correct Coding Initiative (NCCI) edit files, which will take effect on July 1. The update includes changes to both procedure-to-procedure (PTP) and add-on code (AOC) edits, as well as medically unlikely edits (MUE).

CMS published updated hospital and practitioner PTP edit files. The quarterly updates typically include additions, deletions, and modifier indicator changes to PTP column one/column two correct coding edits and the PTP mutually exclusive code edits in the Outpatient Code Editor.

The list of AOC edits is updated on an annual basis, but CMS occasionally provides quarterly updates. The agency published an updated AOC edit file for the third quarter, so revenue integrity professionals should download the new version and check for additions, revisions, and deletions.

CMS also posted updated MUE tables for practitioner, outpatient hospital, and durable medical equipment supplier services. Each MUE table includes updated Healthcare Common Procedure Coding System/Current Procedural Terminology (CPT®) codes and their associated MUE values or the maximum units of service that a provider would report under most circumstances for a single beneficiary on a single date of service.

Revenue integrity professionals should keep the latest version of all three edit files on hand, but they should be diligent in validating dates of service on claims. The date of the change only affects claims with dates of service on or after the day the new tables were last updated. Managing AOC edits, PTP edits, and MUEs can be difficult, so review strategies for staying up to date with NCCI changes.