Free tool · CMS NCCI edits
Claim scrubber
Check CPT codes, modifiers, units, and diagnoses together before you submit — and see exactly which edit would trigger a denial and how to fix it.
Reference tool only. Results are based on CMS NCCI edits and general coding rules and don’t guarantee payment. Verify payer policies and documentation. CPT® is a registered trademark of the American Medical Association; no CPT descriptions are shown.
What it checks
Four layers of pre-submission edits
NCCI procedure pairs
Flags codes that CMS bundles together, and tells you whether modifier 59, XE/XS/XP/XU, 25 or a laterality modifier can separate them.
MUE unit limits
Compares billed units with CMS Medically Unlikely Edits — per line or per day, depending on the code.
Modifier logic
Catches 25 on non-E/M codes, 26 + TC together, 59 with X modifiers, 50 with RT/LT, and E/M billed with a procedure without 25.
Diagnosis checks
Verifies each ICD-10-CM code is billable, pointers are valid, external-cause codes aren’t first, and RT/LT matches the diagnosis side.
FAQ
About the claim scrubber
Which payers do these edits apply to?
The procedure-pair and unit checks use the CMS NCCI practitioner edits for Medicare. Many commercial payers and Medicaid programs follow NCCI closely, but always confirm payer-specific policies.
How current is the NCCI data?
CMS publishes new NCCI files every quarter. Enhancely loads them automatically, and each result shows which quarter was used.
Does it check whether a diagnosis supports the procedure?
Not yet. Medical-necessity coverage (LCDs and NCDs) varies by Medicare contractor and is the next feature we’re adding.
Is it safe to use with patient claims?
Enter only codes, modifiers, units, and dates — no names, member IDs, or other patient information. Nothing you enter is stored.
Let us scrub every claim for you.
Our certified billing team catches edits before submission and works the denials that slip through. Start with a free 48-hour audit.