Can You Bill Other Codes With 97602? NCCI Edits Explained
97602 has 366 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 97602, but may be paid separately when a modifier (e.g. 59 or X{EPSU}) is clinically appropriate and documented:
019960213T0216T0708T0709T1100011720117211190011901290002901029015290352904029044290462904929055290582906529075290852908629105291252912629130291312920029240292602928029305293252934529355293582936529405294252943529440294452945029505295152952029530295402955029580295812958464400644056440864415644166441764418644206442164425644306443564445644466444764448644496445064451644546446164463644666446764468644696447364474644796448364486644876448864489644906449366987963729637496375963769637797164
Never separately payable (indicator 0)
These codes are bundled into 97602 and no modifier will allow separate payment:
0010000102001030010400120001240012600140001420014400145001470014800160001620016400170001720017400176001900019200210002120021400215002160021800220002220030000320003220032600350003520040000402004040040600410004500045400470004720047400500005200052200524005280052900530005320053400537005390054000541005420054600548005500056000561005620056300566005800060000604006200062500626006300063200635006400067000700007020073000731007320075000752007540075600770007900079200794007960079700800008020081100812008130082000830008320083400836008400084200844008460084800851008600086200864008650086600868008700087200873008800088200902009040090600908009100091200914009160091800920009210092200924009260092800930009320093400936009380094000942009440094800950009520111201120011300114001150011600117001173012000120201210012120121401215012200123001232012340125001260012700127201274013200134001360013800138201390013920140001402014040142001430014320144001442014440146201464014700147201474014800148201484014860149001500015020152001522016100162001622016300163401636016380165001652016540165601670016800171001712017140171601730017320174001742017440175601758017600177001772017800178201810018200182901830018320184001842018440185001852018600191601920019220192401925019260193001931019320193301951019520195801960019610196201963019650196601967019900199101992365913659269990965239760797608
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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