CMS originally developed the Medically Unlikely Edit (MUE) program to reduce the paid claims error rate for Part B claims. The first edits were implemented January 1, 2007. Subsequently there have been quarterly updates increasing the number of edits. Visit the NCCI main page on the CMS site.
National Correct Coding Initiative Policy Manual for Medicare Services can be accessed here: https://www.cms.gov/medicare/national-correct-coding-initiative-edits/ncci-policy-manual-medicare
A revised annual version of the National Correct Coding Initiative Policy Manual for Medicare Services effective January 1, 2021, was posted December 18, 2020.
Quarterly updates are posted here.
Find CMS’s MUE FAQs HERE.
FREE Downloads from CMS
FY2021
- Hospital PTP Edits v272r0 effective July 1, 2021 (579,423 records) 0001M/80050 – 27894/G0471 (posted 06/01/2021)
- Hospital PTP Edits v272r0 effective July 1, 2021 (521,537 records) 28001/0213T – 49999/49570 (posted 06/01/2021)
- Hospital PTP Edits v272r0 effective July 1, 2021 (385,708 records) 50010/0213T – 79999/36000 (posted 06/01/2021)
- Hospital PTP Edits v272r0 effective July 1, 2021 (203,425 records) 80003/80002 – U0003/U0004 (posted 06/01/2021)
- Practitioner PTP Edits v272r0 effective July 1, 2021 (620,389 records) 0001M/36591 – 25999/96523 (posted 06/01/2021)
- Practitioner PTP Edits v272r0 effective July 1, 2021 (605,582 records) 26010/01810 – 36909/J2001 (posted 06/01/2021)
- Practitioner PTP Edits v272r0 effective July 1, 2021 (584,943 records) 37140/0213T – 60699/96523 (posted 06/01/2021)
- Practitioner PTP Edits v272r0 effective July 1, 2021 (644,928 records) : 61000/0213T – U0003/U0004 (posted 06/01/2021)
- Hospital PTP Edits v271r0 effective April 1, 2021 (579,297 records) 0001M/80050 – 27894/G0471 (posted 03/01/2021)
- Hospital PTP Edits v271r0 effective April 1, 2021 (521,532 records) 28001/0213T – 49999/49570 (posted 03/01/2021)
- Hospital PTP Edits v271r0 effective April 1, 2021 (385,700 records) 50010/0213T – 79999/36000 (posted 03/01/2021)
- Hospital PTP Edits v271r0 effective April 1, 2021 (203,371 records) 80003/80002 –R0075/R0070 (posted 03/01/2021)
- Practitioner PTP Edits v271r0 effective April 1, 2021 (620,263 records) 0001M/36591 – 25999/96523 (posted 03/01/2021)
- Practitioner PTP Edits v271r0 effective April 1, 2021 (605,577 records) 26010/01810 – 36909/J2001 (posted 03/01/2021)
- Practitioner PTP Edits v271r0 effective April 1, 2021 (584,943 records) 37140/0213T – 60699/96523 (posted 03/01/2021)
- Practitioner PTP Edits v271r0 effective April 1, 2021 (644,832 records) : 61000/0213T – R0075/R0070 (posted 03/01/2021)
FY2020
- Hospital PTP Edits v26.0 effective January 1, 2020 (535,099 records) 0001M/80050 – 27894/G0471
- Hospital PTP Edits v26.0 effective January 1, 2020 (504,685 records) 28001/0213T – 49999/49570
- Hospital PTP Edits v26.0 effective January 1, 2020 (374,673 records) 50010/0213T – 79999/36000
- Hospital PTP Edits v26.0 effective January 1, 2020 (165,996 records) 80003/80002 –R0075/R0070
- Practitioner PTP Edits v26.0 effective January 1, 2020 (532,510 records) 0001M/36591 – 26992/G0471
- Practitioner PTP Edits v26.0 effective January 1, 2020 (529,304 records) 27000/01995 – 37799/96523
- Practitioner PTP Edits v26.0 effective January 1, 2020 (503,060 records) 38100/0213T – 61888/G0471
- Practitioner PTP Edits v26.0 effective January 1, 2020 (562,155 records) : 62000/0213T – R0075/R0070
- Hospital PTP Edits v25.3 effective October 1, 2019 (511,109 records) 0001M/80050 – 27894/G0471
- Hospital PTP Edits v25.3 effective October 1, 2019 (496,801 records) 28001/0213T – 49999/49570
- Hospital PTP Edits v25.3 effective October 1, 2019 (366,930 records) 50010/0213T – 79999/36000
- Hospital PTP Edits v25.3 effective October 1, 2019 (156,339 records) 80003/80002 –R0075/R0070
- Practitioner PTP Edits v25.3 effective October 1, 2019 (561,144 records) 0001M/36591 – 26992/G0471
- Practitioner PTP Edits v25.3 effective October 1, 2019 (491,337 records) 27000/01995 – 37799/96523
- Practitioner PTP Edits v25.3 effective October 1, 2019 (531,167 records) 38100/0213T – 61888/G0471
- Practitioner PTP Edits v25.3 effective October 1, 2019 (489,612 records) : 62000/0213T – R0075/R0070
ARCHIVES: https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Manual-Archive
more useful links for providers below:
How to Use The National Correct Coding Initiative (NCCI) Tools [PDF, 2MB]
Medicare Claim Review Programs Booklet on MR, NCCI Edits, MUEs, CERT, and RAC (PDF, 14 pgs, 1.73 MB)
MLN Matters Number: MM5402 – Medically Unlikely Edits (MUEs) Announcement, January 2, 2007 (PDF, 2 pgs, 78 KB)
Letter Announcing Publication of MUEs, dated September 18, 2008 (PDF, 2 pgs, 51 KB)
Transmittal 1386: Quarterly Update to CCI Edits, Version 14.0, Effective 01/01/2008 (also referred to as Change Request 5824) (PDF, 5 pgs, 154 KB)
MLN Matters Number: MM5824 – Qtrly Update, v14.0, Effective 01/01/2008 (PDF, 2 pgs, 72 KB)
NCCI Policy Manual for Medicare Services – Effective 1/1/2015 (zip file of 15 documents)
NCCI Policy Manual for Medicare Services – Effective 1/1/2014 (zip file of 15 documents)
NCCI Policy Manual for Medicare Services – Updated 10/1/10 (PDF as ZIP file, 551kb)
NCCI Policy Manual for Medicare Services – Updated 4/9/09 (PDF as ZIP file, 444 KB)
Chapter 23 – Fee Schedule Administration and Coding Requirements [PDF, 1MB]
Correspondence Language Manual for Medicare Services – Effective April 1, 2014 [PDF, 197KB]
Modifier 59 Article: Proper Usage Regarding Distinct Procedural Service – Updated 10/28/14 [PDF, 130KB]
Medicaid NCCI File Names and Formats
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