NCCI Code Pairs — 86304
Complete listing of CMS National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits involving HCPCS/CPT code 86304.
27 Total Edits
10 as Column 1
17 as Column 2
← View HCPCS 86304 Detail Page
Column 1 Pairs 86304 is the primary code
When 86304 is reported as the Column 1 (comprehensive) code, the paired Column 2 code is bundled and generally not separately payable.
Medicare Facility (Hospital Outpatient) — 2 pairs
| Paired Code |
Mod
Modifier Indicator: 0 = not allowed, 1 = modifier may permit separate reporting, 9 = N/A
|
Rationale | Effective | End Date |
|---|---|---|---|---|
| 86316 · CCI |
1
Modifier allowed — a NCCI-associated modifier may permit separate reporting
|
Misuse of Column Two code with Column One code | 2002-04-01 | 2199-12-31 |
| 86294 · CCI |
1
Modifier allowed — a NCCI-associated modifier may permit separate reporting
|
More extensive procedure | 2002-04-01 | 2199-12-31 |
Medicare Practitioner — 3 pairs
| Paired Code |
Mod
Modifier Indicator: 0 = not allowed, 1 = modifier may permit separate reporting, 9 = N/A
|
Rationale | Effective | End Date |
|---|---|---|---|---|
| 96523 · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
CPT Manual or CMS manual coding instruction | 2019-04-01 | 2199-12-31 |
| 86294 · CCI |
1
Modifier allowed — a NCCI-associated modifier may permit separate reporting
|
More extensive procedure | 2002-04-01 | 2199-12-31 |
| 86316 · CCI |
1
Modifier allowed — a NCCI-associated modifier may permit separate reporting
|
Misuse of Column Two code with Column One code | 2002-04-01 | 2199-12-31 |
Medicaid Facility — 2 pairs
| Paired Code |
Mod
Modifier Indicator: 0 = not allowed, 1 = modifier may permit separate reporting, 9 = N/A
|
Rationale | Effective | End Date |
|---|---|---|---|---|
| 86294 · CCI |
1
Modifier allowed — a NCCI-associated modifier may permit separate reporting
|
More extensive procedure | 2010-10-01 | 2199-12-31 |
| 86316 · CCI |
1
Modifier allowed — a NCCI-associated modifier may permit separate reporting
|
Misuse of Column Two code with Column One code | 2010-10-01 | 2199-12-31 |
Medicaid Practitioner — 3 pairs
| Paired Code |
Mod
Modifier Indicator: 0 = not allowed, 1 = modifier may permit separate reporting, 9 = N/A
|
Rationale | Effective | End Date |
|---|---|---|---|---|
| 96523 · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
CPT Manual or CMS manual coding instruction | 2019-04-01 | 2199-12-31 |
| 86316 · CCI |
1
Modifier allowed — a NCCI-associated modifier may permit separate reporting
|
Misuse of Column Two code with Column One code | 2010-10-01 | 2199-12-31 |
| 86294 · CCI |
1
Modifier allowed — a NCCI-associated modifier may permit separate reporting
|
More extensive procedure | 2010-10-01 | 2199-12-31 |
Column 2 Pairs 86304 is the bundled code
When 86304 is reported as the Column 2 (component) code, it is bundled into the Column 1 comprehensive code and generally not separately payable.
Medicare Facility (Hospital Outpatient) — 5 pairs
| Paired Code |
Mod
Modifier Indicator: 0 = not allowed, 1 = modifier may permit separate reporting, 9 = N/A
|
Rationale | Effective | End Date |
|---|---|---|---|---|
| 0407U · CCI |
1
Modifier allowed — a NCCI-associated modifier may permit separate reporting
|
HCPCS/CPT procedure code definition | 2024-07-01 | 2199-12-31 |
| 0105U · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
HCPCS/CPT procedure code definition | 2020-01-01 | 2199-12-31 |
| 0003U · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
HCPCS/CPT procedure code definition | 2017-10-01 | 2199-12-31 |
| 81503 · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
CPT Manual or CMS manual coding instruction | 2013-01-01 | 2199-12-31 |
| 81500 · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
CPT Manual or CMS manual coding instruction | 2013-01-01 | 2199-12-31 |
Medicare Practitioner — 2 pairs
| Paired Code |
Mod
Modifier Indicator: 0 = not allowed, 1 = modifier may permit separate reporting, 9 = N/A
|
Rationale | Effective | End Date |
|---|---|---|---|---|
| 81500 · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
CPT Manual or CMS manual coding instruction | 2013-01-01 | 2199-12-31 |
| 81503 · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
CPT Manual or CMS manual coding instruction | 2013-01-01 | 2199-12-31 |
Medicaid Facility — 5 pairs
| Paired Code |
Mod
Modifier Indicator: 0 = not allowed, 1 = modifier may permit separate reporting, 9 = N/A
|
Rationale | Effective | End Date |
|---|---|---|---|---|
| 0407U · CCI |
1
Modifier allowed — a NCCI-associated modifier may permit separate reporting
|
HCPCS/CPT procedure code definition | 2024-07-01 | 2199-12-31 |
| 0105U · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
HCPCS/CPT procedure code definition | 2020-01-01 | 2199-12-31 |
| 0003U · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
HCPCS/CPT procedure code definition | 2017-10-01 | 2199-12-31 |
| 81500 · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
CPT Manual or CMS manual coding instruction | 2013-01-01 | 2199-12-31 |
| 81503 · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
CPT Manual or CMS manual coding instruction | 2013-01-01 | 2199-12-31 |
Medicaid Practitioner — 5 pairs
| Paired Code |
Mod
Modifier Indicator: 0 = not allowed, 1 = modifier may permit separate reporting, 9 = N/A
|
Rationale | Effective | End Date |
|---|---|---|---|---|
| 0407U · CCI |
1
Modifier allowed — a NCCI-associated modifier may permit separate reporting
|
HCPCS/CPT procedure code definition | 2024-07-01 | 2199-12-31 |
| 0105U · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
HCPCS/CPT procedure code definition | 2020-01-01 | 2199-12-31 |
| 0003U · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
HCPCS/CPT procedure code definition | 2017-10-01 | 2199-12-31 |
| 81503 · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
CPT Manual or CMS manual coding instruction | 2013-01-01 | 2199-12-31 |
| 81500 · CCI |
0
Modifier not allowed — codes cannot be reported together under any circumstances
|
CPT Manual or CMS manual coding instruction | 2013-01-01 | 2199-12-31 |
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