Education article

How CPT codes get edited, paired, and reduced

The work in the operating room is not always the work that survives on a claim. NCCI edits, add-on code rules, and multiple-procedure reductions determine how code sets are paid.

NCCI first

Before dollars are modeled, code pairs have to survive NCCI policy. Some pairs are blocked, some can be bypassed with appropriate modifiers, and others are allowed.

Then multiple procedure logic

After edits and add-on logic, MPFS multiple-procedure indicators determine which procedures are ranked, reduced, or exempt from standard reduction rules.