How to Use Modifier Indicators with NCCI Edits (2018-10-31)

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Oct 31st, 2018

To verify if clinical circumstances might justify the use of a modifier when billing code pairs, look at the NCCI edits and the modifier indicator.  Medicare may have restrictions on the use of a modifier used to bypass an edit.  This important part of coding can alert a payer or auditor if used inappropriately. 

MODIFIER INDICATOR  DEFINITION

0 (Not Allowed) There are no modifiers associated with NCCI that are allowed to be used with this PTP code pair; there are no circumstances in which both procedures of the PTP code pair should be paid for the same beneficiary on the same day by the same provider.

1 (Allowed) The modifiers associated with NCCI are allowed with this PTP code pair when appropriate.

9 (Not Applicable) This indicator means that an NCCI edit does not apply to this PTP code pair. The edit for this PTP code pair was deleted retroactively.