Column 1 and Column 2 Copy link
When both codes of a pair are reported, the Column 1 code is eligible for payment and the Column 2 code is denied, unless the edit allows a bypass modifier and one is appropriately reported. The edit governs how the pair is paid. It does not mean the Column 2 service wasn’t performed.
The modifier indicator Copy link
A modifier indicator of 0 means no modifier bypasses the edit. An indicator of 1 means an NCCI PTP-associated modifier can bypass it when the clinical circumstances justify one—generally a separate encounter, a separate anatomic site, or a separate specimen. Those modifiers are the anatomic modifiers (E1–E4, FA, F1–F9, TA, T1–T9, LT, RT, LC, LD, RC, LM, RI), the global surgery modifiers (24, 25, 57, 58, 78, 79), and 27, 59, 91, XE, XS, XP, and XU. Modifiers 22, 76, and 77 do not bypass a PTP edit. An indicator of 9 means the modifier question does not apply: CMS uses it for pairs whose deletion date equals their effective date.
| Modifier indicator | What it allows |
|---|---|
| 0 | No modifier bypasses the edit |
| 1 | An NCCI PTP-associated modifier can bypass the edit when the clinical circumstances justify it |
| 9 | Not applicable—used for pairs whose deletion date equals their effective date |
Practitioner vs. hospital outpatient edition Copy link
CMS publishes separate PTP edit files for practitioner claims and for hospital outpatient claims. The practitioner edition applies to physician billing and is the one this site uses. CMS updates it quarterly, like the fee schedule.
Check a code pair and its unit limits Copy link
Enter a code to see its MUE limit and how many NCCI edits it’s in. Add a second code to check whether the two can be billed together on the same day.
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NCCI Q4 2026 edit files
93000 is in 6,211 active procedure-to-procedure edits: 10 no modifier can bypass, 6,201 an NCCI-associated modifier can.
- 93000 MUE limit
- 3 units per day
- MAI 3: Date-of-service edit, clinical benchmarks. Units summed the same way, but a contractor may bypass the edit on evidence the units were provided, correctly coded, and medically necessary.
- 99213 MUE limit
- 2 units per day
- MAI 3: Date-of-service edit, clinical benchmarks. Units summed the same way, but a contractor may bypass the edit on evidence the units were provided, correctly coded, and medically necessary.
93000 + 99213: The Q4 2026 NCCI edit files we hold list no active procedure-to-procedure edit for this pair. Other Medicare coverage and billing rules can still apply.
This checker covers NCCI procedure-to-procedure edits only—edits that modifier 59 or a more specific X{EPSU} modifier can bypass. It does not cover modifier 25. If 93000 is an evaluation and management visit billed the same day as a separately identifiable procedure, modifier 25 usually matters instead. That decision depends on documentation, not this checker. Source: CMS National Correct Coding Initiative (NCCI) Edits (Q4 2026).
See every current NCCI pair for 93000
Edits and limits from CMS’s NCCI files for practitioners. Whether a modifier fits a claim depends on the documentation, which this lookup doesn’t judge.
Frequently asked Copy link
Does a PTP edit mean the Column 2 code is never payable?
Not necessarily. If the modifier indicator is 1 and the services were genuinely separate, an appropriate modifier can bypass the edit. If the indicator is 0, no modifier can.
Which modifiers can bypass a PTP edit?
Only the NCCI PTP-associated modifiers, and only when the modifier indicator is 1: anatomic modifiers (such as LT, RT, and the finger and toe modifiers), global surgery modifiers (24, 25, 57, 58, 78, 79), and 27, 59, 91, XE, XS, XP, and XU. Modifiers 22, 76, and 77 do not bypass a PTP edit.
Do PTP edits change over time?
Yes. CMS updates PTP edits quarterly, and each pair carries effective and deletion dates, so the pairs and modifier indicators in effect can differ between releases.
Sources Copy link
Written from primary CMS sources—see how we source, compute, and verify everything on this site.
- If a provider reports both codes of a PTP edit pair for the same beneficiary on the same date of service, the Column One code is eligible for payment and the Column Two code is denied unless a clinically appropriate NCCI PTP-associated modifier is allowed and reported. —CMS Medicare NCCI Policy Manual (2026)
- The NCCI PTP-associated modifiers are the anatomic modifiers (E1-E4, FA, F1-F9, TA, T1-T9, LT, RT, LC, LD, RC, LM, RI), the global surgery modifiers (24, 25, 57, 58, 78, 79), and modifiers 27, 59, 91, XE, XS, XP, and XU. Modifiers 22, 76, and 77 do not bypass a PTP edit. —CMS Medicare NCCI Policy Manual (2026)
- A correct coding modifier indicator of 9 means the use of PTP-associated modifiers is not specified; CMS assigns it to every code pair whose deletion date is the same as its effective date. —CMS Medicare NCCI Policy Manual (2026)
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