NCCI Edits Version 27.3 Effective October 1, 2021
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!
All material posted on our website is intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without prior written approval of Gawenda Seminars & Consulting, Inc.
All material posted on our website is the intellectual property of Gawenda Seminars & Consulting, Inc. and can’t be used, reproduced, or posted as your own material without the prior written approval of Gawenda Seminars & Consulting, Inc.
This article is not intended to and does not serve as legal advice or as consultative services, but is for general information purposes only.
When you release the Q1 cheat sheet for the new year, you put all of the changes for therapy in red (Thank you!). Do you do that for these quarterly ones as well? I do not see any red on the Oct 1 edition.
Changes are posted in either red or blue and each color means something different. If a CPT code is in red, that means it’s a new NCCI edit with this Version. If a CPT code is in Blue, it means a deleted NCCI edit beginning with this version. If you see no CPT codes in red or blue, that means there are no additions or deletions for this version.
We are seeing denials in July 2021 reading xX Denied cms NCCI unbundling? Can you please elaborate on what this might mean?
Without knowing the insurance, the combination of codes billed and seeing the EOB’s, very difficult for me to answer.
Thank you for the quick reply. Here’s a little insight into the denials:
Humana and/or Buckeye Managed Care
Denying OT claims with the following combo’s billed on the same day: 97535,97542 or 97140 billed with 97530
Denying PT claims with the following combo’s billed on the same day: 97110, 97112, 97116 or 97140 billed with 97530
And denying both PT/OT claims when 97530 is billed by itself on the same day by each discipline.
59 Modifiers are applied to every CPT code billed in conjunction with 97530.
Thank you again.
I would recommend you read this article: https://gawendaseminars.com/ncci-edit-changes-for-aetna-cigna-and-humana/
If you have additional questions, unfortunately, you will need to contact the insurance carrier.