The Centers for Medicare and Medicaid Services (CMS) has published the National Correct Coding Initiative (NCCI) edits, Version 27.3, for dates of service October 1, 2021 – December 31, 2021. These NCCI edits are not only used by traditional Medicare, but also by many state Medicaid and Managed Medicaid plans as well as many commercial insurance carriers and workers compensation insurance carriers.
As Gawenda Seminars & Consulting (GSC) has done every quarter for their Gold Members, GSC has published their “cheat sheet” for the use of modifier 59 in outpatient therapy under NCCI edit Version 27.3. 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 and when modifier 59 is not only required, but will also tell you if modifier 59 is not allowed.
This is a great Gold Member benefit. The “cheat sheet” can be accessed by clicking HERE and you will need to log in to view the “cheat sheet”.
I hope you have found this “cheat sheet” to be a valuable resource every quarter. Thank you for being a Gold Member!