The Centers for Medicare & Medicaid Services (CMS) has identified an issue with National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits related to Current Procedural Terminology (CPT) code 90480 for COVID-19 vaccine administration.
Due to PTP edits implemented on Oct. 1, 2025, claims are being incorrectly denied when COVID-19 administration and other vaccines are billed on the same day. To address this, CMS is expediting the implementation of the January 2026 NCCI PTP edits. CMS has instructed the Medicare administrative contractors (MACs) that within 30 business days of implementation of the January 2026 files, the MACs shall adjust erroneous denials and adjudicate appeals to allow payment as long as there is no other reason to deny the claim.
Pharmacies should consider continuing to use Modifier 59 on claims in the meantime.
