NCCI edits for HCPCS G0428
CMS lists 57 active pairs with modifier indicator 0 (no NCCI-associated modifier bypasses those edits) and 109 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 0 units 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.
- 01250 01250 denies
- 01320 01320 denies
- 01400 01400 denies
- 0213T 0213T denies
- 0216T 0216T denies
- 29874 29874 denies
- 29877 29877 denies
- 36591 36591 denies
- 36592 36592 denies
- 62320 62320 denies
- 62321 62321 denies
- 62322 62322 denies
- 62323 62323 denies
- 62324 62324 denies
- 62325 62325 denies
- 62326 62326 denies
- 62327 62327 denies
- 64400 64400 denies
- 64405 64405 denies
- 64408 64408 denies
- 64415 64415 denies
- 64416 64416 denies
- 64417 64417 denies
- 64418 64418 denies
- 64420 64420 denies
- 64421 64421 denies
- 64425 64425 denies
- 64430 64430 denies
- 64435 64435 denies
- 64445 64445 denies
- 64446 64446 denies
- 64447 64447 denies
- 64448 64448 denies
- 64449 64449 denies
- 64451 64451 denies
- 64461 64461 denies
- 64463 64463 denies
- 64479 64479 denies
- 64483 64483 denies
- 64490 64490 denies
- 64493 64493 denies
- 64505 64505 denies
- 64510 64510 denies
- 64517 64517 denies
- 64520 64520 denies
- 64530 64530 denies
- 69990 69990 denies
- 96523 96523 denies
- 99155 99155 denies
- 99156 99156 denies
Showing 50 of 57. The plain-text version contains every pair.
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.
- 0566T 0566T denies
- 0596T 0596T denies
- 0597T 0597T denies
- 0708T 0708T denies
- 0709T 0709T denies
- 0903T 0903T denies
- 0904T 0904T denies
- 0905T 0905T denies
- 11010 G0428 denies
- 11011 G0428 denies
- 11012 G0428 denies
- 20600 20600 denies
- 20604 20604 denies
- 20605 20605 denies
- 20606 20606 denies
- 20610 20610 denies
- 20611 20611 denies
- 20704 20704 denies
- 27328 G0428 denies
- 27329 G0428 denies
- 27331 G0428 denies
- 27332 G0428 denies
- 27333 G0428 denies
- 27339 G0428 denies
- 27345 G0428 denies
- 27347 27347 denies
- 27364 G0428 denies
- 27403 G0428 denies
- 27437 G0428 denies
- 27438 G0428 denies
- 27440 G0428 denies
- 27441 G0428 denies
- 27442 G0428 denies
- 27443 G0428 denies
- 27446 G0428 denies
- 27447 G0428 denies
- 27455 G0428 denies
- 27486 G0428 denies
- 27487 G0428 denies
- 27570 27570 denies
- 27580 G0428 denies
- 29868 G0428 denies
- 29870 29870 denies
- 29871 29871 denies
- 29875 29875 denies
- 29880 G0428 denies
- 29881 29881 denies
- 29882 29882 denies
- 29883 29883 denies
- 29884 29884 denies
Showing 50 of 109. The plain-text version contains every pair.
NCCI edits are not a coverage determination or a substitute for the current CMS NCCI Policy Manual. Deleted pairs are excluded from this page.