NCCI edits for CPT 38240
CMS lists 16 active pairs with modifier indicator 0 (no NCCI-associated modifier bypasses those edits) and 21 pairs with modifier indicator 1, where an NCCI-associated modifier may be allowed when the documentation supports it.
NCCI release: Q4 2026. Source: CMS National Correct Coding Initiative (NCCI) Edits. Complete plain-text list.
Check a paired code Copy link
Medically Unlikely Edit (MUE) Copy link
The published MUE is 1 unit per patient per date of service.
Not separately payable together Copy link
Modifier indicator 0: the edit cannot be bypassed with an NCCI-associated modifier. Each row names the code that denies. CMS writes every edit as an ordered pair: the Column Two code is denied and the Column One code is paid.
- 0263T 38240 denies
- 0264T 38240 denies
- 0265T 38240 denies
- 36591 36591 denies
- 36592 36592 denies
- 38205 38240 denies
- 38206 38240 denies
- 38225 38225 denies
- 38227 38227 denies
- 38228 38228 denies
- 38241 38240 denies
- 38242 38242 denies
- 38243 38243 denies
- 69990 69990 denies
- 86950 86950 denies
- 96523 96523 denies
Modifier may be allowed Copy link
Modifier indicator 1: an NCCI-associated modifier may be used when the circumstances and documentation support it. Each row names the Column Two code, which is the one denied absent an allowed modifier.
- 99211 99211 denies
- 99212 99212 denies
- 99213 99213 denies
- 99214 99214 denies
- 99215 99215 denies
- 99221 99221 denies
- 99222 99222 denies
- 99223 99223 denies
- 99231 99231 denies
- 99232 99232 denies
- 99233 99233 denies
- 99234 99234 denies
- 99235 99235 denies
- 99236 99236 denies
- 99238 99238 denies
- 99239 99239 denies
- 99471 99471 denies
- 99472 99472 denies
- 99475 99475 denies
- 99476 99476 denies
- G0463 G0463 denies
NCCI edits are not a coverage determination or a substitute for the current CMS NCCI Policy Manual. Deleted pairs are excluded from this page.