National Correct Coding Initiative (NCCI) edits directly impact how Medicare, Medicaid, and commercial insurance carriers reimburse outpatient therapy services. Therapy providers must understand how insurers use NCCI edits to bundle CPT codes and how modifier 59 allows appropriate unbundling when services meet medical necessity and coding requirements. Providers rely on modifier 59 to receive separate payment for multiple CPT codes billed on the same date of service, making it the most commonly used and most frequently audited CPT modifier. They must apply modifier 59 correctly within a single therapy discipline or across multiple disciplines—such as physical therapy, occupational therapy, and speech-language pathology—when the same organization provides services on the same date.
This 1-hour on-demand online course provides step-by-step instruction on NCCI edits and correct modifier 59 usage for outpatient therapy billing. Participants will learn which CPT codes require modifier 59, how to apply it correctly on the claim form, and how the January 1, 2026 Procedure-to-Procedure (PTP) NCCI edit changes impact physical therapy, occupational therapy, and speech-language pathology services. The course includes real-world billing examples across all three therapy disciplines, including how speech therapy billing affects physical and occupational therapy codes billed on the same day. Participants also receive the Gawenda Seminars & Consulting NCCI Version 32.0 cheat sheet, a practical reference tool designed to help providers determine when modifier 59 is appropriate. In addition, the course explains how reinstated NCCI edits affect billing to major commercial insurance carriers, including Aetna, Anthem Blue Cross, Humana, and others.
At the conclusion of this online presentation, participants will be able to:
- Describe and understand column 1/column 2 NCCI edits and which CPT code(s) requires modifier 59
- Be able to use the NCCI edit “cheat sheet” to append modifier-59 to the correct CPT code(S) on the claim form
- Recite how one discipline’s billing may cause another discipline’s billing to require modifier 59
- Understand the documentation that must be present in the medical record to support the use of modifier 59
- Identify any changes to NCCI edits as they pertain to outpatient physical, occupational and speech therapy services with Version 32.0 compared to Version 31.0
- Explain the current status of the XE, XP, XS, and XU subsets of modifier 59
Rick Gawenda, P.T., graduated in 1991 with a Bachelor of Science in Physical Therapy from Wayne State University, Detroit, Michigan. Mr. Gawenda is currently the President and founder of Gawenda Seminars & Consulting, Inc. He has provided valuable education and consulting to hospitals, rehabilitation agencies, private practices, nursing homes, and his peers in the areas of CPT and ICD-10 coding, billing, documentation, reimbursement, and compliance as it pertains to outpatient therapy services as well as denial management and the appeals process for Medicare denied claims. Mr. Gawenda’s website, https://gawendaseminars.com/, provides a valuable source of information on rehabilitation rules and regulations, coding, documentation, and reimbursement.
Mr. Gawenda is a member of the American Physical Therapy Association (APTA) and Michigan Physical Therapy Association (MPTA). Mr. Gawenda is the Past President of the Section on Health Policy & Administration of the APTA as well as Past President of the Michigan Association of Medical Rehabilitation Program Administrators.
Mr. Gawenda is also the author of “The How-To Manual for Rehab Documentation: A Complete Guide to Increasing Reimbursement and Reducing Denials” and “Coding and Billing For Outpatient Rehab Made Easy: Proper Use of CPT Codes, ICD-9 Codes and Modifiers”.
Physical therapists, physical therapist assistants, occupational therapists, occupational therapy assistants, speech-language pathologists, private practice owners and practice administrators, coders and office managers at private practices, as well as directors, managers, supervisors, compliance officers, risk managers, and billers in skilled nursing facilities, hospital outpatient therapy departments, schools, rehabilitation agencies, home health agencies, and comprehensive outpatient rehabilitation facilities.
In addition to the expertise and advice presented during this online conference, you’ll also receive a handout (in PDF format) that will include related reference links as well as Gawenda Seminars & Consulting NCCI Edit Version 32.0 “Cheat Sheet” for use of modifier 59 in outpatient therapy.
This online course has not been submitted to any state board or national organization for CEU approval. A certificate of attendance will be available upon completion of the course for each participant and may be adequate for credit in some states; you will need to contact your state licensing regulatory body to determine whether or not credit will be granted for this online conference. We provide no additional information for CEU approval.
This online course was approximately 1 hour (including Q&A).
There are no refunds for no shows or any other reasons once you register and payment is received. We are not responsible for organization firewalls or computer software issues that may interfere and/or prohibit your connection to the webinar portion of the presentation.
Venue system requirements:
- Microsoft Internet Explorer 7+, Mozilla Firefox 2.5+, Safari, or Chrome
- 1024 x 768 screen resolution
- Stable Internet connection, DSL or above
- Wired Internet connection; wireless is not recommended
- Flash Player 9 or higher
- Disable pop-up blockers
- Computer speakers for participants
Note: Android Smart Phones (i.e. iPhone) are not compatible.
In order to ensure a successful connection to this online course, please take a moment to conduct a system test by clicking this link: http://web.telspan.com/systemcheck
***Application Sharing does not need to be operational to view this course recording link.
*** This COURSE RECORDING and HANDOUTS is not to be distributed outside of your organization. If you have a larger organization and have multiple locations, then please contact us here for pricing.
