CMS Manual System Department of Health &
Human Services (DHHS)
Pub 100-04 Medicare Claims Processing Centers for Medicare &
Medicaid Services (CMS)
Transmittal: 12988 Date: December 5, 2024
Change Request 13878
SUBJECT: Combined Common Edits/Enhancements Modules (CCEM) Code Set Update
I. SUMMARY OF CHANGES: The purpose of this Change Request (CR) is to direct the Medicare shared
system maintainers to obtain the most recent external code sets, and use them to update the necessary tables
and/or reference files as part of the CCEM software utilized by the A/B Medicare Administrative
Contractors (MACs). This recurring update notification applies to publication 100-04, chapter 24, section
50.3.4.
EFFECTIVE DATE: April 1, 2025
*Unless otherwise specified, the effective date is the date of service.
IMPLEMENTATION DATE: April 7, 2025
Disclaimer for manual changes only: The revision date and transmittal number apply only to red
italicized material. Any other material was previously published and remains unchanged. However, if this
revision contains a table of contents, you will receive the new/revised information only, and not the entire
table of contents.
II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated)
R=REVISED, N=NEW, D=DELETED-Only One Per Row.
R/N/D CHAPTER / SECTION / SUBSECTION / TITLE
N/A N/A
III. FUNDING:
For Medicare Administrative Contractors (MACs):
The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined
in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is
not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically
authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to
be outside the current scope of work, the contractor shall withhold performance on the part(s) in question
and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions
regarding continued performance requirements.
IV. ATTACHMENTS:
Recurring Update Notification
Attachment - Recurring Update Notification
Pub. 100-04 Transmittal: 12988 Date: December 5, 2024 Change Request: 13878
SUBJECT: Combined Common Edits/Enhancements Modules (CCEM) Code Set Update
EFFECTIVE DATE: April 1, 2025
*Unless otherwise specified, the effective date is the date of service.
IMPLEMENTATION DATE: April 7, 2025
I. SUMMARY OF CHANGES: The purpose of this Change Request (CR) is to direct the Medicare
shared system maintainers to obtain the most recent external code sets, and use them to update the necessary
tables and/or reference files as part of the CCEM software utilized by the A/B Medicare Administrative
Contractors (MACs). This recurring update notification applies to publication 100-04, chapter 24, section
50.3.4.
II. GENERAL INFORMATION
A. Background: The purpose of this CR is to direct the Medicare shared system maintainers to obtain
the most recent external code sets, and use them to update the necessary tables and/or reference files as part
of the CCEM software utilized by the A/B MACs.
In order for the Medicare fee-for-service program to correctly and accurately edit the inbound Accredited
Standards Committee X12 version 5010 837 Institutional, 837 Professional claims, and the 276 Claim Status
Inquiry, several code set updates are required. These are common code sets that are used across both the Part
A and Part B CCEMs and are updated on a regular basis.
B. Policy: Health Insurance Reform: Modifications to the Health Insurance Portability and
Accountability Act: Final Rules published in the Federal Register on January 16, 2009, by the Department of
Health and Human Services at 45 Code for Federal Regulation Part 162.
III. BUSINESS REQUIREMENTS TABLE
"Shall" denotes a mandatory requirement, and "should" denotes an optional requirement.
Number Requirement Responsibility
A/B MAC DME Shared-System Maintainers Other
A B HHH FISS MCS VMS CWF
MAC
13878.1 The Shared System X
Maintainers of the CCEM
software shall update the
tables in business
requirement 13878.1.1 for
the external code sets
required for claim editing.
13878.1.1 The Shared System X
Maintainers of the CCEM
software shall update the
maintainer maintained
Number Requirement Responsibility
A/B MAC DME Shared-System Maintainers Other
A B HHH FISS MCS VMS CWF
MAC
Spitab tables for the
following external codes
sets:
• Country Codes
(International
Organization for
Standardization
(ISO) 3166-1)
• Country Subdivision
Codes (ISO 3166-2)
• State Codes (US,
CA, MX)
• Not Otherwise
Classified (NOC)
Procedure Codes (as
defined by CMS)
• National Uniform
Billing
Committee Condition
Codes – that are
valid for use on the
837 Professional per
National Uniform
Claim Committee
Note: Continue to check for
codes until the 30 day point
of release.
13878.1.1.1 The Shared System X
Maintainers of the
CCEM software shall refer
all inquiries regarding
NOC Procedure Codes (as
defined by CMS)
to
[email protected].
13878.2 The Shared System X
Maintainers of the CCEM
software shall distribute a
copy of the NOC Procedure
Codes (as defined by CMS)
code set to
[email protected] 30
days prior to the quarterly
release.
IV. PROVIDER EDUCATION
None
Impacted Contractors: None
V. SUPPORTING INFORMATION
Section A: Recommendations and supporting information associated with listed requirements: N/A
"Should" denotes a recommendation.
X-Ref Recommendations or other supporting information:
Requirement
Number
Section B: All other recommendations and supporting information:N/A
VI. CONTACTS
Post-Implementation Contact(s): Contact your Contracting Officer's Representative (COR).
VII. FUNDING
Section A: For Medicare Administrative Contractors (MACs):
The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined
in your contract. CMS does not construe this as a change to the MAC Statement of Work. The contractor is
not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically
authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to
be outside the current scope of work, the contractor shall withhold performance on the part(s) in question
and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions
regarding continued performance requirements.
ATTACHMENTS: 0
