The Centers for Medicare and Medicaid Services (CMS) has released the quarterly update of the National Correct Coding Initiative (NCCI) edits. NCCI Edit Version 23.1 is in effect for dates of service April 1, 2017 – June 30, 2017. NCCI edits are used by CMS in the outpatient therapy realm in all practice settings including therapist owned private practice, physician owned therapy practices, home health agencies providing Part B therapy in the home, rehabilitation agencies, skilled nursing facilities doing Part B therapy, comprehensive outpatient rehabilitation facilities and hospital outpatient therapy departments.
Regarding hospitals, this would include critical access hospitals and Medicare beneficiaries who may be an inpatient, but does not have any Part A benefits, thus the therapy that was provided is being billed under their Part B benefits. This would also include Medicare beneficiaries who are seen by therapy while in the emergency department or under observation status and do not get admitted to the hospital. The therapy the beneficiary received in these settings are being billed to the Medicare program as outpatient therapy services under their Part B benefits.
Version 23.1 contains several changes regarding the new physical and occupational therapy evaluation and reevaluation CPT codes for both the private practice version and non-private practice version. To access NCCI Edits Version 23.1, click HERE.