MedicaidBilling CodesMedium impact
Medicaid Management Information System Updated with NCCI Quarter 4 2025 Files
Nevada Medicaid·NV·Billing & Coding
Effective date
Oct 1, 2025
We identified it
Jun 21, 2026
Summary
Nevada Medicaid has updated its system with CMS National Correct Coding Initiative (NCCI) Quarter 4 2025 files, affecting how procedure code combinations and units of service are processed. The updates include new Medically Unlikely Edits (MUE) and Procedure-to-Procedure (PTP) edits that will prevent improper payments when incorrect code combinations are reported or service limitations are exceeded.
Action Required
Before October 1, 2025: Billing team must review current Nevada Medicaid claims for procedure code combinations and units of service to ensure compliance with new NCCI edits. Verify billing software is updated to handle new MUE and PTP edits. Review CMS NCCI edit files at https://www.cms.gov/medicare/coding-billing/ncci-medicaid to identify specific code combination restrictions. Claims with incorrect code combinations or excessive units will be denied after the effective date.