The National Correct Coding Initiative was established by CMS to prevent unbundling and the incorrect or inaccurate billing of a combination of codes. These are also called NCCI or CCI edits. CMS identifies individual services that are components of a more inclusive service and governs the reporting of combinations of CPT codes on the same date of service.
On January 1, 2013, CMS implemented a CCI edit that relates to preventive medicine services and immunization administration codes. It was 1 of about 300 changes that affected evaluation and management (E/M) services and vaccine administration. In this edit, the vaccine administration code would supersede the E/M or preventive visit code as the only reimbursable code.
To override this edit and report these two services as significant and separately identifiable, you may attach the 25 modifier to the E/M or Preventive Medicine visit codes, listed below.
- Immunization Administration codes: 90460-90461, 90471-90474
- Preventive Medicine Service codes: 99381-99397
Next Steps
To align and adopt the CCI edits, this CCI edit is scheduled to go-live August 24, 2022.
If you are providing an E/M visit, such as a Preventive Medicine visit, and administer vaccines on the same date of service for the same patient, please append the 25 modifier to the E/M or Preventive Medicine visit code to allow reporting of the 2 separate services.
You may review the following for more information:
- Commercial Reimbursement Policy (PDF)
- Prior Communication - Changes to Correct Coding Initiative (CCI) and Outpatient Code Editor (OCE) Edits for Claims Processing
