Can You Bill Other Codes With 97112? NCCI Edits Explained
97112 has 58 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 97112, but may be paid separately when a modifier (e.g. 59 or X{EPSU}) is clinically appropriate and documented:
0213T0216T6232062321623226232362324623256232662327644006440564408644156441664417644186442064421644256443064435644456444664447644486444964450644516445464461644636446664467644686446964473644746447964480644836448464486644876448864489644906449364505645106451764520645309702297036
Never separately payable (indicator 0)
These codes are bundled into 97112 and no modifier will allow separate payment:
365913659296523
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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