The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The purpose of the NCCI PTP edits is to ensure the most comprehensive groups of codes are billed rather than the component parts. Additionally, NCCI edits check for mutually exclusive code pairs. These edits were implemented to ensure that only appropriate codes are grouped and priced. The unit-of-service edits determine the maximum allowed number of services for each HCPCS code.

To access the NCCI edits from the CMS website, click on the link below. For PT’s, OT’s, and SLP’s in private practice as well as physician owned therapy clinics, click on NCCI Edits–Physicians. For all other settings, click on NCCI Edits–Hospital Outpatient PPS.

In addition, Gawenda Seminars & Consulting has created a “cheat sheet” for the use of modifier 59 in outpatient therapy. This “cheat sheet” includes the most commonly used CPT codes by PT, OT and SLP and lists what can and can’t be billed on the same date of service by the same provider. This is a great Gold Member benefit. The “cheat sheet” can be accessed below once you log in.

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