Can You Bill Other Codes With 36415? NCCI Edits Explained

36415 has 4 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 36415, but may be paid separately when a modifier (e.g. 59 or X{EPSU}) is clinically appropriate and documented:

• 99211

Never separately payable (indicator 0)

These codes are bundled into 36415 and no modifier will allow separate payment:

• 36591
• 36592
• 96523

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.