Core Endpoints

NCCI Edits

Access National Correct Coding Initiative (NCCI) code pair edits and Medically Unlikely Edits (MUEs) for claims validation and compliance checking.

Check Code Pair Edit

Validate whether two codes can be billed together according to NCCI edit rules.

GET/v1/ncci/edit

curl -X GET "https://api.medref.io/v1/ncci/edit?code1=99213&code2=99214" \
  -H "Authorization: Bearer YOUR_API_KEY"

Response

{
  "column1_code": "99213",
  "column2_code": "99214",
  "edit_exists": true,
  "modifier_allowed": false,
  "effective_date": "2024-01-01",
  "deletion_date": null,
  "rationale": "Mutually exclusive codes - same category E/M service",
  "recommendation": "Bill the higher-value code (99214) only"
}

Get MUE Limit

Retrieve Medically Unlikely Edit (MUE) values for a code, which define the maximum units of service that would typically be reported per day.

GET/v1/ncci/mue/{code}

curl -X GET "https://api.medref.io/v1/ncci/mue/99213" \
  -H "Authorization: Bearer YOUR_API_KEY"

Response

{
  "code": "99213",
  "practitioner_services": {
    "mue_value": 1,
    "mue_adjudication_indicator": "3",
    "rationale": "Per day limit based on nature of service"
  },
  "outpatient_hospital": {
    "mue_value": 1,
    "mue_adjudication_indicator": "3",
    "rationale": "Per day limit based on nature of service"
  },
  "effective_date": "2024-01-01"
}

Bulk Validation

Validate multiple code pairs in a single request for efficient claims scrubbing.

POST/v1/ncci/validate

curl -X POST "https://api.medref.io/v1/ncci/validate" \
  -H "Authorization: Bearer YOUR_API_KEY" \
  -H "Content-Type: application/json" \
  -d '{
    "codes": ["99213", "99214", "36415", "85025"],
    "check_mue": true,
    "units": { "36415": 2 }
  }'

// Response includes all edit pairs and MUE violations found

MUE Adjudication Indicators

Value	Description
1	Claim line edit - deny entire line if exceeded
2	Date of service edit - sum units per date
3	Date of service edit - per line per date