NCCI Edits Version 28.1 Effective April 1, 2022

March 28, 2022
Rick Gawenda

National Correct Coding Initiative (NCCI) Edits Version 28.1 are effective with dates of service April 1, 2022 – June 30, 2022. To access Gawenda Seminars & Consulting, Inc. therapy specific NCCI edit reference sheet that will assist you in determining whether modifier 59 is required or not, click HERE.

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  1. I just want to confirm that the re-evaluation 97164 does not require a 59 modifier anymore with any procedure codes billed such as 97112, 97110, 97530 and that 97530 does not require a 59 modifier when billed with 97140??

    1. I will defer you to the current version of NCCI edits. If a CPT code is not in the far right hand column, it means that code can be provided and reimbursed the same day as the code in the far left hand side and modifier 59 is not required. You can also view the past versions and look for CPT codes in the right hand column that are highlighted in blue. That would mean that edit was deleted with that version and then in future versions, you will not see that CPT code in the far right hand column.

  2. Just recently we are being asked to add the 59 modifier to some Sr. Advantage patients. Has something changed recently?