NCCI Edits & Modifier 59: Version 28.0

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Your purchase includes this Webinar Playback Link and Handouts with Certificate of Attendance.
This webinar will provide participants with information on NCCI Edits Version 28.0 that became effective with dates of service beginning on January 1, 2022 and lasting through March 31, 2022. Learn the new, revised and deleted NCCI edits that are not only used by CMS, but also by other insurance carriers like state Medicaid programs, Anthem BC, Aetna, and Humana, for providers of outpatient physical, occupational and speech therapy services.  

Click below to learn more about the course objectives.

National Correct Coding Initiative (NCCI) edits are used by the Medicare program, state Medicaid programs as well as some commercial insurance carriers and workers compensation carriers to combat abusive and fraudulent billing practices in outpatient therapy as well as other services. Modifier 59 is used by outpatient therapy providers to bypass certain NCCI edits and allow the payment of more than 1 CPT code billed on the same day that an insurance carrier may consider should be bundled and separate payment should not be made. Because of this, modifier 59 is not only the most commonly used modifier, it is also the most commonly abused modifier. In addition, the need to use modifier 59 is not only within the same discipline but may also be required when a patient is receiving multiple disciplines from the same provider on the same date of service. Version 28.0 becomes effective with dates of service between January 1 – March 31, 2022.

This 1-hour webinar program will explain NCCI edits, the use of modifier 59 and what code(s) to append modifier 59 to on the claim form as well as provide the participants with any significant changes to the procedure-to-procedure (PTP) edits effective beginning on January 1, 2022 that will impact outpatient physical, occupational and speech therapy services. In addition, the webinar will provide detailed and realistic examples when providers of outpatient therapy services would utilize modifier 59. Examples will include all 3 disciplines as well as how speech therapy billing impacts the physical and occupational therapy codes billed the same day. Lastly, participants will receive Gawenda Seminars & Consulting NCCI Version 28.0 “cheat sheet” to assist them in knowing when to apply modifier 59 to a CPT code on the claim form. In addition, the webinar will explain how the reinstated NCCI edits will impact the billing of outpatient therapy services to commercial insurance carriers such as Aetna, Anthem BC, Humana and many others.

If you have questions about registration or logistics for this webinar conference, please contact the Webinar Conference Manager Michelle Gawenda

661.350.6187

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