Can You Bill Other Codes With 11055? NCCI Edits Explained
11055 has 259 current NCCI PTP edits: codes that are bundled into it and can’t be reported separately, except where an appropriate modifier is allowed.
Check a specific pair with the NCCI checker →
Allowed with an appropriate modifier (indicator 1)
These codes are bundled into 11055, but may be paid separately when a modifier (e.g. 59 or X{EPSU}) is clinically appropriate and documented:
0596T0597T0903T0904T0905T1100011042110431104411200117201172111765119001200212004120051200612007120111201312014120151201612017120181202012021120321203412035120361203712042120441204512046120471205212053120541205512056120571310013101131021312013121131221313113132131331315113152131531710617107171081711017250172601726117262172631726417266172701727117272172731727417276172801728117282172831728417286295503600036400364053640636410364203642536430364403660036640437525170151702517036445064454920129201493000930059301093040930419304293318933559400294200946809468194690958129581395816958199582295829959559636096361963659636696367963689637296374963759637696377970229759797598976029760597606976079760899211992129921399214992159922199222992239923199232992339923499235992369923899239992429924399244992459925299253992549925599291992929930499305993069930799308993099931099315993169934199342993449934599347993489934999350993749937599377993789949599496G0168G0463G0471
Never separately payable (indicator 0)
These codes are bundled into 11055 and no modifier will allow separate payment:
0213T0216T36591365926232062321623226232362324623256232662327644006440564408644156441664417644186442064421644256443064435644456444664447644486444964451644616446264463644666446764468644696447364474644796448064483644846448664487644886448964490644916449264493644946449564505645106451764520645306999096523991559915699157994469944799448994499945199452
How NCCI PTP edits work
NCCI Procedure-to-Procedure edits pair a Column 1 (comprehensive) code with Column 2 (component) codes. When both are billed for the same patient on the same day, the Column 2 code is denied unless the edit’s modifier indicator is 1 and a clinically appropriate modifier is appended.
Modifiers
A modifier indicator of 1 means a modifier (commonly 59 or the more specific X{EPSU} modifiers) may allow separate payment when the services are truly distinct and documented. Indicator 0 means no modifier will bypass the edit.
Good to know
- Practitioner NCCI edits; hospital/outpatient edits differ.
- Edits update quarterly — always check the current CMS file.
- A modifier must be clinically justified and documented, not used to bypass a valid edit.
- Individual payers may apply additional bundling rules.
More free billing tools: all NCCI edits · NCCI checker · denial codes · Medicare fees
NCCI Procedure-to-Procedure edits from CMS (practitioner). Edits change quarterly and payer application varies; a modifier must be clinically appropriate and documented. Verify against the current CMS NCCI files and your payer's policy before billing.
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