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Chapter 4.5. Division of Workers' Compensation
SUBCHAPTER 1. ADMINISTRATIVE DIRECTOR -ADMINISTRATIVE RULES
Article 5.3. Official Medical Fee Schedule

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§9789.12.13. Correct Coding Initiative.

(a) The National Correct Coding Initiative Edits (“NCCI”) adopted by the CMS shall apply to payments for medical services under the Physician Fee Schedule. Except where payment ground rules differ from the Medicare ground rules, claims administrators shall apply the NCCI physician coding edits and medically unlikely edits to bills to determine appropriate payment. Claims Administrators shall utilize the National Correct Coding Initiative Coding Policy Manual for Medicare Services. If a billing is reduced or denied reimbursement because of application of the NCCI, the claims administrator must notify the physician or qualified non-physician practitioner of the basis for the denial, including the fact that the determination was made in accordance with the NCCI.

(b) The National Correct Coding Initiative Coding Policy Manual may be obtained from the CMS website: http://www.cms.hhs.gov/NationalCorrectCodInitEd/. See section 9789.19 for the adopted version of the NCCI Coding Policy Manual, by date of service.

The Manual may also be purchased from the National Technical Information Service (NTIS) at: http://www.ntis.gov/products/cci.aspx or by contacting NTIS at 1-800-363-2068 or 703-605-6060.

(c) Medically Unlikely Edits are published by CMS on its website at: http://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html in the document “Practitioner Services MUE Table.” See section 9789.19 for the adopted version of the Practitioner Services MUE Table, by date of service.

(d) Physician NCCI Edits are published by CMS on its website at: http://www.cms.gov/Medicare/ Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html in the documents “Physician CCI Edits”. See section 9789.19 for the adopted version of the Physician CCI Edits, by date of service.

Note: Authority: Sections 133, 4603.5, 5307.1 and 5307.3, Labor Code. Reference: Sections 4600, 5307.1 and 5307.11, Labor Code.

HISTORY

1. New section filed 9-24-2013; operative 1-1-2014. Submitted to OAL as a file and print only pursuant to Government Code section 11340.9(g) (Register 2013, No. 39).

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