Can You Bill Other Codes With 28292? NCCI Edits Explained
28292 has 310 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 28292, but may be paid separately when a modifier (e.g. 59 or X{EPSU}) is clinically appropriate and documented:
0490T0566T0594T0596T0597T0708T0709T0718T0903T0904T0905T1100011001110041100511006110121104211043110441104511046110471142011421114221142311424117301175012001120021200412005120061200712011120131201412015120161201712018120201202112031120321203412035120361203712041120421204412045120461204712051120521205312054120551205612057131001310113102131201312113122131311313213133131511315213153140401404120527205502055120552205532056020561206002060420605206062061020611206502069020704280102801128022280242805228054280722808028090280922810428108281112812228124281262815028153281602820028208282342824028270282852828828289282912830628307283102831528476284852864529425295402955029580295813600036400364053640636410364203642536430364403660036640437525170151702517036445064454644556446664467644686446964473644746470476000770017700292012920149300093005930109304093041930429331893355940029420094680946819469095812958139581695819958229582995955963609636196365963669636796368963729637496375963769637797597975989760299211992129921399214992159922199222992239923199232992339923499235992369923899239992429924399244992459925299253992549925599291992929930499305993069930799308993099931099315993169934799348993499935099374993759937799378G0463G0471J0670
Never separately payable (indicator 0)
These codes are bundled into 28292 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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