Two sets of Medicare NCCI edit files. CMS lists the Practitioner and Hospital PTP Edits v323r0 as "Effective Oct. 1, 2026; Posted September 2, 2026," and the Q4 MUE tables (practitioner, facility outpatient hospital, DME supplier) as "Effective October 1, 2026; Posted September 1, 2026." CMS also says it "posts changes to each of its NCCI PTP published edit files on a quarterly basis," so these are the Q4 2026 versions.

What PTP edits are, in CMS's words

Procedure-to-procedure (PTP) edits are about pairs of codes. CMS defines them this way:

CMS: "National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits prevent inappropriate payment of services that should not be reported together."

Each edit has a Column One code and a Column Two code. Here's how CMS describes what happens when both are reported:

CMS: "If a provider reports the two codes of an edit pair for the same beneficiary on the same date of service, the Column One code is eligible for payment, but the Column Two code is denied unless a clinically appropriate NCCI PTP-associated modifier is also reported."

Both are quoted in full because the wording matters, especially the "clinically appropriate" condition on the modifier.

The Q4 2026 PTP files

CMS: "CMS posts changes to each of its NCCI PTP published edit files on a quarterly basis."

For this quarter, CMS lists:

file CMS status
Practitioner PTP Edits v323r0 Effective Oct. 1, 2026; Posted September 2, 2026
Hospital PTP Edits v323r0 Effective Oct. 1, 2026; Posted September 2, 2026

What an MUE is

Medically unlikely edits (MUEs) are about units, not pairs. CMS's definition:

CMS: "An MUE is the maximum units of service (UOS) reported for a HCPCS/CPT code on the vast majority of appropriately reported claims by the same provider/supplier for the same beneficiary on the same date of service."

CMS: "Not all HCPCS/CPT codes have an MUE."

For this quarter, CMS marks its Q4 MUE tables for practitioner, facility outpatient hospital, and DME supplier services "Effective October 1, 2026; Posted September 1, 2026."

Some MUE values are confidential

Not every MUE value is on the CMS site:

CMS: "Although CMS publishes most MUE values on its website, other MUE values are confidential. Confidential MUE values are not releasable."

A short check for the billing lead this week

These are practical suggestions, not CMS rules:

  1. Confirm what's loaded. Ask your clearinghouse or claim-scrubber vendor whether the v323r0 PTP files and the October 1 MUE tables are what's running now.
  2. Look at your own codes. Pull the CMS quarterly change files for the codes you bill most.
  3. Modifiers only when clinically appropriate. That's CMS's condition. Check the CMS NCCI materials and your MAC, not a forum post.
  4. Watch for the next quarter. Keep an eye on the CMS PTP and MUE pages for the next quarterly posting.

When in doubt, check the source, your MAC, or your payer contract.

FAQ

What are NCCI PTP edits?

CMS: "National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits prevent inappropriate payment of services that should not be reported together."

Which PTP edit files took effect October 1, 2026?

CMS lists Practitioner PTP Edits v323r0 and Hospital PTP Edits v323r0, each "Effective Oct. 1, 2026; Posted September 2, 2026."

What is an MUE?

CMS: "An MUE is the maximum units of service (UOS) reported for a HCPCS/CPT code on the vast majority of appropriately reported claims by the same provider/supplier for the same beneficiary on the same date of service." CMS also notes, "Not all HCPCS/CPT codes have an MUE."

Are all MUE values published?

No. CMS: "Although CMS publishes most MUE values on its website, other MUE values are confidential. Confidential MUE values are not releasable."

Related resources

Know what's moving, what's stuck, what happens next. Start with one queue.

This page is run by RxRev.

Sources: - CMS, Medicare NCCI Procedure to Procedure (PTP) Edits - CMS, Medicare NCCI Medically Unlikely Edits (MUEs) (page last modified 08/31/2026)