Can You Bill Other Codes With 28110? NCCI Edits Explained
28110 has 267 current NCCI PTP edits: codes that are bundled into it and can’t be reported separately, except where an appropriate modifier is allowed.
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Allowed with an appropriate modifier (indicator 1)
These codes are bundled into 28110, but may be paid separately when a modifier (e.g. 59 or X{EPSU}) is clinically appropriate and documented:
0490T0596T0597T0708T0709T0718T0903T0904T0905T110001100111004110051100611010110111101211042110431104411045110461104712001120021200412005120061200712011120131201412015120161201712018120201202112031120321203412035120361203712041120421204412045120461204712051120521205312054120551205612057131001310113102131201312113122131311313213133131511315213153202202022520240202452052720550205512055220553205602056128022280522807228086280882819028192281932822028225282322823429130291312954036000364003640536406364103642036425364303644036600366404375251701517025170364450644546445564466644676446864469644736447492012920149300093005930109304093041930429331893355940029420094680946819469095812958139581695819958229582995955963609636196365963669636796368963729637496375963769637797597975989760299211992129921399214992159922199222992239923199232992339923499235992369923899239992429924399244992459925299253992549925599291992929930499305993069930799308993099931099315993169934799348993499935099374993759937799378G0463G0471J0670
Never separately payable (indicator 0)
These codes are bundled into 28110 and no modifier will allow separate payment:
014700213T0216T365913659262320623216232262323623246232562326623276440064405644086441564416644176441864420644216442564430644356444564446644476444864449644516446164462644636447964480644836448464486644876448864489644906449164492644936449464495645056451064517645206453069990965239915599156991579944699447994489944999451994529949599496
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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