How to check a Medicaid code pair before you bill
Medicaid's quarterly code-pair file lists the same-day pairs Medicaid won't pay together, and the pairs Medicaid pays with a modifier your note supports.
Co-founder, JotPsych
You billed Medicaid for two services for one patient on one day, and Medicaid denied one code. Look the pair up in Medicaid's code-pair file before your next claim.
| Services | Column one: Medicaid pays | Column two: Medicaid denies | Modifier indicator |
|---|---|---|---|
| Two psychotherapy sessions | 90834 | 90832 | 0: Medicaid never pays both |
| Psychotherapy and an office visit | 90837 | 99214 | 0: Medicaid never pays both |
| Family psychotherapy and an office visit | 90847 | 99214 | 1: Medicaid pays both with a modifier your note supports |
| Injection and an office visit | 96372 | 99214 | 1: Medicaid pays both with a modifier your note supports |
From Medicaid's practitioner code-pair file for October 1 to December 31, 2026. In the first two pairs, Medicaid pays only the column one code, even with a modifier.
- Find the pair in this quarter's file. The Centers for Medicare & Medicaid Services posts a new Medicaid code-pair file each quarter, and the October file covers your visits from October 1 to December 31, 2026. Look for your two codes in either order.
- Read which code is column one. Medicaid pays your column one code and denies your column two code. The rule holds when one clinician bills both codes for one patient on one date, per the federal guide to Medicaid's code-pair tools.
- Read the modifier indicator. Zero means Medicaid never pays both codes. One means Medicaid pays both when your claim carries a modifier and your note shows a separate service.
- Add a modifier only when your note shows two services. Modifier 25 marks a separate office visit, and modifier 59 never goes on an office visit, per chapter 1 of Medicaid's coding policy manual. Don't add a modifier only to get past an edit. Your state may limit the modifiers it takes.
The federal guide to Medicaid's code-pair tools sets these outcomes. On an indicator 1 pair, Medicaid still denies column two when your claim has no modifier.
In the last two pairs, Medicaid pays the 99214 too when the 99214 carries modifier 25 and your note shows a significant, separate office visit. Medicaid managed care plans don't have to run these edits, per the federal Medicaid edits page, so ask each plan you bill which edits it runs.
Your state runs the edits in its own claims system, so check your state's Medicaid manual too. For a Medicare claim, read our guide to Medicare's same-day code pairs, since Medicaid's edits differ from Medicare's, per the federal Medicaid edits page.
On JotPsych's claim page, read why Medicaid denied the second code, then start the correction as a draft.
Book 15 minutes- Centers for Medicare & Medicaid Services, Medicaid National Correct Coding Initiative (NCCI) edit files: the practitioner procedure-to-procedure file for dates of service October 1 to December 31, 2026, MCD-PTP-PractitionerServices-Effective_10012026.txt. Read October 5, 2026.
- Centers for Medicare & Medicaid Services, MLN9018659, How to Use the Medicaid NCCI Tools, chapter 2: column one and column two codes, and modifier indicators 0, 1, and 9.
- Centers for Medicare & Medicaid Services, Medicaid NCCI Policy Manual, 2026, chapter 1: modifiers 25 and 59, and no modifier added solely to bypass an edit.
- Centers for Medicare & Medicaid Services, Medicaid NCCI, page last modified March 4, 2026: the edits are optional for managed care organizations, and Medicaid's edits differ from Medicare's.
- JotPsych, How to bill Medicare for two services on the same day.