The National Correct Coding Initiative (NCCI) Edits, Version 29.0, become effective with dates of service January 1, 2023 – March 31, 2023. NCCI edits are used by the Centers for Medicare and Medicaid Services (CMS) to combat abusive and fraudulent billing practices. In addition, many state Medicaid programs, workers compensation carriers and commercial insurance carriers also utilize NCCI edits when processing outpatient physical, occupational and speech therapy claims.
Gawenda Seminars & Consulting provides a NCCI Edit Therapy Specific reference sheet for our members that enable the members to know when modifier 59 is and is not required to be appended to a CPT code(s) on the claim form.
To access the most current version of this reference sheet, click HERE. Once on the page, click on 2023 and then select the applicable version.
If you submit claims on a 1500-claim form to Medicare, you are a private practice. If you submit claims on a UB-04 claim form to Medicare, you are a non-private practice.
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 following this 59 modifier cheat sheet, which code do you add the 59 modifier to? The CPT code in the left column or the one in the right?
Column 2 code