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Stop the denials that cannot be appealed.

Some NCCI pairs deny with no modifier override at all. This reference lists every active hard-stop pair for the 30 most-billed codes, generated from v32.3 · Practitioner PTP, so the conflict is caught before the claim leaves.

What is in the file

CSV

One row per hard-stop pair: the primary code, the code that is bundled into it, the edit's effective date and CMS's rationale. Hard-stop means modifier indicator 0: modifier 59 and the X{EPSU} modifiers do not unbundle it, so the column-2 code denies whenever both are billed for the same patient on the same date.

Covers: 99213, 99214, 99203, 99204, 90837, 90834, 99283, 99284, 20610, 17000, 93000, 36415, 80053, 85025, 71045, 45378, 97110, 99395, 90686, G0439, 73562, 70450, 99223, 99232, 96372, 97140, 29881, 66984, 43239, 12001. For any other code, the same pairs are on its code page and in the claim checker, which tests a whole claim against all 1.7 million active edits.

You will hear from us when a new denial-prevention guide is published, and not otherwise. Reply to any message to stop. No patient information is involved at any point.

WHY AN EMAIL

Guides that are actually written.

Modifier 25, modifier 59, medical-necessity denials and the appeal that wins each one: as each guide is published it goes to this list first. The patient tools on this site never ask for an address.

RVU-based Medicare benchmark, before payer adjustments, OPPS caps, sequestration, and patient cost sharing. An estimate, not a payment guarantee.