NCCI Medically Unlikely Edits (MUEs)
type: Dataset
description: Medically Unlikely Edits (MUEs) define for each HCPCS / CPT code the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service. Practitioner services also refers to ambulatory surgical centers. DME refers to provider claims for durable medical equipment. The CMS National Correct Coding Initiative (NCCI) promotes national correct coding methodologies and reduces improper coding which may result in inappropriate payments of Medicare Part B claims and Medicaid claims. NCCI procedure-to-procedure (PTP) edits define pairs of Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes that should not be reported together for a variety of reasons. The purpose of the PTP edits is to prevent improper payments when incorrect code combinations are reported. The edits in this dataset are active for the dates indicated within. This file should NOT be used by state Medicaid programs as their edit file. Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2017 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. For more information, visit https://www.medicaid.gov/medicaid/program-integrity/ncci/index.html.
issued: 2025-12-02T03:22:39.751284
modified: 2025-12-02T03:22:39.751289
contact point: Organization
  fn: Medicaid.gov
keyword: amerigeo
keyword: amerigeoss
keyword: ckan
keyword: geo
keyword: geoss
keyword: national
keyword: north-america
keyword: united-states

xsl
type: Distribution
format: xsl
issued: 2018-05-23T19:28:03.904037
modified: 2025-12-02T03:22:39.744787
access URL: https://data.medicaid.gov/api/views/8pny-kgh5/rows.xml
media type: application/unknown

json
type: Distribution
format: JSON
issued: 2018-05-23T19:28:03.904033
modified: 2025-12-02T03:22:39.744368
access URL: https://data.medicaid.gov/api/views/8pny-kgh5/rows.json
media type: application/unknown

csv
type: Distribution
format: CSV
issued: 2018-05-23T19:28:03.904006
modified: 2025-12-02T03:22:39.743506
access URL: https://data.medicaid.gov/api/views/8pny-kgh5/rows.csv
media type: application/unknown

rdf
type: Distribution
format: RDF
issued: 2018-05-23T19:28:03.904025
modified: 2025-12-02T03:22:39.743952
access URL: https://data.medicaid.gov/api/views/8pny-kgh5/rows.rdf
media type: application/unknown

US Migrating
type: Agent