NCCI Edits Version 23.0 Update

The Centers for Medicare and Medicaid Services (CMS) released National Correct Coding Initiative (NCCI) edits Version 23.0 in November 2016 that is effective for dates of service January 1, 2017 – March 31, 2017. As expected, there were significant additions and deletions due to the new physical and occupational therapy evaluation and reevaluation CPT codes that became effective for dates of service on and after January 1, 2017.

The NCCI edits are not only used by the Medicare program for outpatient therapy services, but are also used by state Medicaid programs as well as some private insurance carriers and workers compensation carriers. Providers who are not aware of the NCCI edits may not have all of their CPT codes paid for on a particular date of service due to the combination of codes being billed on the claim form. This is true for all outpatient therapy settings, including private practice and physician-owned therapy practices. In this article, I will discuss issues and concerns with NCCI edit Version 23.0 for all outpatient therapy settings, including, hospital outpatient therapy departments, skilled nursing facilities, rehabilitation agencies, home health agencies doing Part B in the home, private practice and physician-owned therapy practices. To access the Gawenda Seminars & Consulting NCCI Edits Therapy “Cheat Sheet”, click HERE.

CMS has acknowledged there are three errors in the CCI edit Version 23.0 used by