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CCI Policy Manual
01/01/2017
by: Centers for Medicare & Medicaid Services
National Correct Coding Initiative Policy Manual for Medicare Services
Revision Date: 1/1/2017
01/01/2017
by: Centers for Medicare & Medicaid Services
Introduction
On December 19, 1989, the Omnibus Budget Reconciliation Act of 1989 (P.L. 101-239) was enacted. Section 6102 of P.L. 101-239 amended Title XVIII of the Social Security Act (the Act) by adding a new section 1848, “Payment for Physicians' Services”. This section of the Act provided for replacing the previous reasonable charge mechanism of actual, customary, and prevailing charges with a resource-based relative value scale (RBRVS) fee schedule that began in 1992.
01/01/2017
by: Centers for Medicare & Medicaid Services
General Correct Coding Policies
A. Introduction
Healthcare providers utilize HCPCS/CPT codes to report medical services performed on patients to Medicare Carriers (A/B MACs processing practitioner service claims) and Fiscal Intermediaries (FIs). HCPCS (Healthcare Common Procedure Coding System) consists of Level I CPT (Current Procedural Terminology) codes and Level II codes. CPT codes are defined in the American Medical Association’s (AMA’s) CPT Manual which is updated and published annually. HCPCS Level II codes are defined by the Centers for Medicare & Medicaid Services (CMS) and are updated throughout the year as necessary. Changes in CPT codes are approved by the AMA CPT Editorial Panel which meets three times per year.
01/01/2017
by: Centers for Medicare & Medicaid Services
Chapter II
Anesthesia Services
CPT Codes 00000 - 09999
A. Introduction
The principles of correct coding discussed in Chapter I apply to the CPT codes in the range 00000-01999. Several general guidelines are repeated in this Chapter. However, those general guidelines from Chapter I not discussed in this chapter are nonetheless applicable.
01/01/2017
by: Centers for Medicare & Medicaid Services
Chapter III
Surgery: Integumentary System
CPT Codes 10000 - 19999
A. Introduction
The principles of correct coding discussed in Chapter I apply to the CPT codes in the range 10000-19999. Several general guidelines are repeated in this Chapter. However, those general guidelines from Chapter I not discussed in this Chapter are nonetheless applicable
01/01/2017
by: Centers for Medicare & Medicaid Services
Chapter IV
Surgery: Musculoskeletal System
CPT Codes 20000 - 29999
A. Introduction
The principles of correct coding discussed in Chapter I apply to the CPT codes in the range 20000-29999. Several general guidelines are repeated in this Chapter. However, those general guidelines from Chapter I not discussed in this Chapter are nonetheless applicable.
01/01/2017
by: Centers for Medicare & Medicaid Services
Chapter V
Surgery: Respiratory, Cardiovascular, Hemic and Lymphatic Systems
CPT Codes 30000 - 39999
A. Introduction
The principles of correct coding discussed in Chapter I apply to the CPT codes in the range 30000-39999. Several general guidelines are repeated in this Chapter. However, those general guidelines from Chapter I not discussed in this Chapter are nonetheless applicable.
01/01/2017
by: Centers for Medicare & Medicaid Services
Surgery: Digestive System
CPT Codes 40000 - 49999
A. Introduction
The principles of correct coding discussed in Chapter I apply to the CPT codes in the range 40000-49999. Several general guidelines are repeated in this Chapter. However, those general guidelines from Chapter I not discussed in this Chapter are nonetheless applicable.
01/01/2017
by: Centers for Medicare & Medicaid Services
Chapter VII
Surgery: Urinary, Male Genital, Female Genital, Maternity Care, and Delivery Systems
CPT Codes 50000 - 59999
A. Introduction
The principles of correct coding discussed in Chapter I apply to the CPT codes in the range 50000-59999. Several general guidelines are repeated in this Chapter. However, those general guidelines from Chapter I not discussed in this Chapter are nonetheless applicable.
01/01/2017
by: Centers for Medicare & Medicaid Services
Chapter VIII
Surgery: Endocrine, Nervous, Eye and Ocular Adnexa, and Auditory Systems
CPT Codes 60000 - 69999
A. Introduction
The principles of correct coding discussed in Chapter I apply to the CPT codes in the range 60000-69999. Several general guidelines are repeated in this Chapter. However, those general guidelines from Chapter I not discussed in this chapter are nonetheless applicable.

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