Every quarter a billing manager somewhere opens a remittance in the second week of the month and finds a run of CO-236 denials on a code pair that paid without trouble for three years. Nothing changed in the practice. The payer's edit table changed, on a schedule that has been public for months, and nobody in the office was watching it. That is the quarterly NCCI update, and the July 1, 2026 version was posted by CMS on June 1, 2026. You have four weeks to read it.
For readers who have never opened one of these files: NCCI stands for National Correct Coding Initiative, a set of edit tables CMS uses to decide which pairs of procedure codes it will not pay together on the same date of service for the same patient. There are three edit families. Procedure-to-procedure (PTP) edits say code A and code B do not pay together unless a modifier explains why they should. Medically unlikely edits (MUEs) cap the units of a single code per day. Add-on code edits check that an add-on code rides with an eligible primary code. Medicare uses all three, most Medicaid programs use a state version, and most commercial payers license the same logic or something very close to it.
This article is about the NCCI edits for July 1, 2026 specifically, what the files contain, and the routine we run in June so that July claims do not surprise anyone.
Key takeaways
- CMS posted practitioner PTP edit version 322r0 on June 1, 2026, effective for dates of service on or after July 1, 2026; the full practitioner file carries 608,227 records.
- The quarterly change files show 2,199 added pairs and 708 deleted pairs, plus modifier indicator changes, and those change files are the only part most practices need to read.
- Filter the additions against your own top 50 CPT codes before July 1; a pair you never bill is not your problem, and a pair you bill 300 times a quarter is a budget item.
- Deleted edits sometimes carry a deletion date earlier than July 1, which means claims denied under that edit may be eligible for resubmission.
- Your practice management system and clearinghouse scrubber update on their own schedule, not CMS's, so confirm the version number they are running.
What the July 1, 2026 files contain
CMS posts NCCI files on its Medicare NCCI PTP Edits page under an announcements section. The July 2026 release is labeled version 322r0 (v322r0), with the note "Effective July 1, 2026; Posted June 1, 2026." There are separate hospital and practitioner file sets. The practitioner set is the one physician offices care about, and it comes in four files split by code range so that each fits in a spreadsheet. The last of the four, the one covering the highest code ranges, holds 608,227 records. The other three are larger, around 675,000 records each.
Nobody should read 600,000 rows. CMS also posts a ZIP labeled Practitioner Services PTP Quarterly Additions, Deletions, and Revisions, which lists only what changed. For this quarter, according to the AAPC's summary of the files, that is 2,199 additions and 708 deletions. The additions run from multianalyte assay code 0002M and proprietary laboratory analysis code 0468U at the low end through to endoscopic defect closure code C9901 paired with small intestine endoscopy code 44379. The deletions include pairs involving PLA codes 0001U and 0029U and molecular pathology code G0452 with PLA code 0423U. That mix tells you something: a large share of the churn this quarter is in laboratory and pathology codes, and if your practice runs an in-office lab or bills PLA codes, this quarter deserves more of your time than most.
Each row in the file has a column one code, a column two code, an effective date, a deletion date (or a placeholder meaning "still active"), and a modifier indicator. The modifier indicator is the part that matters at the desk. A 0 means no modifier will separate the pair; column two simply will not pay. A 1 means a valid NCCI modifier (59, XE, XS, XP, XU, or an anatomic modifier such as RT, LT, or the finger and toe modifiers) will allow both to pay when the documentation supports it. A 9 means the edit was deleted and the indicator is not applicable.
The routine we run in June
We treat the quarterly NCCI update like a fee schedule load: a scheduled task with an owner, not something the coder does when she remembers. The steps are the same every quarter.
- Download the change files, not the full tables. Pull the practitioner quarterly additions, deletions and revisions ZIP from the CMS NCCI PTP page. Save it with the version number in the filename so you can prove later which version you loaded.
- Build your top-code list. From your practice management system, pull the 50 most frequently billed CPT and HCPCS codes for the last two quarters, by count and by dollars. Most practices have a list they already trust; use it.
- Filter the additions against that list. In a spreadsheet, keep only added rows where either column one or column two is on your top-code list. In a family medicine practice this typically leaves a few dozen rows. In a multi-specialty group it can be several hundred.
- Read the modifier indicator for every survivor. Indicator 0 pairs need a workflow decision: stop billing the pair, or accept that column two will not pay. Indicator 1 pairs need a documentation decision: when is the second service genuinely separate, and who checks that before the claim goes out?
- Check the deletions for early deletion dates. Some deleted pairs are marked with a deletion date earlier than the current quarter. When that happens, claims that were denied under that edit for dates of service after the deletion date may be resubmitted. Run a denial report for CO-236 and CO-97 on the affected pairs and count the money.
- Confirm the version your tools are running. Ask the practice management vendor and the clearinghouse which NCCI version their scrubber has loaded and when v322r0 goes live on their side. In our experience, the answer is often "the first or second week of July," which leaves a gap where July claims are scrubbed against April edits.
The denial codes that tell you an edit fired
When a payer applies a PTP edit, the remittance usually carries one of a small set of claim adjustment reason codes (CARCs) and remark codes (RARCs). Knowing them lets you build a report that isolates edit denials from everything else.
| Code | What the payer is saying | What it usually means for NCCI |
|---|---|---|
| CO-236 | This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day | A PTP edit fired; check the modifier indicator |
| CO-97 | The benefit for this service is included in the payment for another service already adjudicated | Bundling; often a PTP pair or a global package issue |
| CO-4 | The procedure code is inconsistent with the modifier used, or a required modifier is missing | An indicator 1 pair billed without an NCCI modifier |
| RARC M80 | Not covered when performed during the same session/date as a previously processed service | Frequently paired with CO-97 on PTP denials |
| RARC N19 | Procedure code incidental to primary procedure | Column two code treated as incidental |
A monthly report of these five codes by CPT pair is, honestly, more useful than most denial dashboards. It shows you exactly which pairs your providers bill together, which ones the payer bundles, and whether the modifier is being applied where it belongs.
Modifier 59 and the X modifiers, once more
An indicator 1 edit can be bypassed with a modifier, and that is where practices get into trouble in both directions. Some never append a modifier and lose payment for legitimately separate services. Others append modifier 59 to everything and become an audit target. The OIG has been writing about modifier 59 misuse since 2005, and it remains a recurring theme in Comprehensive Error Rate Testing findings.
Since January 1, 2015, CMS has accepted four more specific modifiers in place of 59: XE (separate encounter), XS (separate structure), XP (separate practitioner) and XU (unusual non-overlapping service). Medicare still accepts 59, but many Medicare administrative contractors and a growing number of commercial payers prefer the X modifiers because they force the biller to state why the services are distinct. Our rule for the practices we work with is simple: the modifier goes on the column two code, it goes on only when the note says why the service was separate, and the coder can point to the sentence. If the coder cannot point to the sentence, the modifier does not go on.
One more thing that trips up offices in July. The edits apply by date of service, not by claim submission date. A claim for a June 28 visit submitted on July 3 is judged against the April version. A claim for a July 1 visit is judged against v322r0. If your scrubber loaded the new tables early or late, you will see mismatched denials at the boundary, and they are worth appealing with a printout of the CMS effective dates.
Medicaid and commercial payers
State Medicaid programs run a separate Medicaid NCCI table, also published by CMS, with its own quarterly file. It is similar but not identical to the Medicare table; some pairs differ, and some states carve out edits by policy. If Medicaid is more than a fifth of your volume, download both files.
Commercial payers are less predictable. Most license NCCI logic and apply it on the CMS schedule, but several layer their own bundling rules on top, and a few lag the CMS quarter by one release. UnitedHealthcare, Aetna and Cigna all publish reimbursement policies that reference NCCI, and their policy update bulletins are where the differences show up. When a commercial denial cites bundling for a pair that is not in the CMS file, ask for the payer's policy citation in writing before you appeal. If you want a second pair of eyes on which payer edits are actually costing you money, that is part of what our RCM audit looks at.
Questions we hear
Do we really need to do this every quarter, or can we wait for denials?
You can wait, and many practices do, but the cost is the gap between the first denied claim and the day someone notices the pattern. That gap is usually four to eight weeks, and in a practice billing a common pair a few hundred times a month it is real money. The June review takes one person half a day. We think that trade is obvious.
Our clearinghouse says its scrubber handles NCCI. Isn't that enough?
It catches the edits it has loaded, on the day it loads them. It does not tell you that a pair your surgeon bills every Tuesday just became indicator 0, and it does not decide whether an X modifier is justified. The scrubber is a safety net, not a policy.
What about MUE changes in July?
MUE files update quarterly too, and the July ones are posted on the same CMS section. Most practices only need to check the MUE values for codes they bill with multiple units: injections, units of drug, wound care, and lab panels. A change from 3 to 2 units on a J code will show up as a partial payment, not a denial, which is why it is easy to miss.
What to do this week
- Download the July 1, 2026 practitioner PTP quarterly change files (v322r0) from the CMS NCCI page and save them with the version in the filename.
- Pull your top 50 billed codes for the last two quarters and filter the 2,199 additions against them.
- List every surviving indicator 0 pair and decide, with the providers, how it will be handled from July 1.
- Run a CO-236, CO-97 and CO-4 denial report for the 708 deleted pairs and flag any with early deletion dates for resubmission.
- Email your practice management vendor and clearinghouse asking for the date v322r0 goes live in their scrubbers, and put that date on the billing calendar.
