North Dakota (ND) Medicaid is updating their physical therapy, occupational therapy and speech language therapy policies. Updated policies include the following:

The National Correct Coding Initiative (NCCI) Edits Version 32.0 are in effect for dates of service January 1, 2026 – March 31, 2026. NCCI edits are used in all outpatient therapy settings for original Medicare and Medicaid beneficiaries. In addition, some Medicare Advantage plans, commercial insurers, and workers compensation programs also utilize the NCCI edits. Gawenda Seminars & Consulting has created a NCCI Edit therapy specific reference sheet for both Medicare and Medicaid. These reference sheets will inform providers when modifier 59 is required on a CPT code on the claim form. In addition, the reference sheet will inform providers

The National Correct Coding Initiative (NCCI) Edits Version 31.2 are in effect for dates of service July 1, 2025 – September 30, 2025. NCCI edits are used in all outpatient therapy settings for original Medicare and Medicaid beneficiaries. In addition, some Medicare Advantage plans, commercial insurers, and workers compensation programs also utilize the NCCI edits. Gawenda Seminars & Consulting has created a NCCI Edit therapy specific reference sheet for both Medicare and Medicaid. These reference sheets will inform providers when modifier 59 is required on a CPT code on the claim form. In addition, the reference sheet will inform providers

The Centers for Medicare and Medicaid Services (CMS) has released the National Correct Coding Initiative (NCCI) edits Version 31.1 for original Medicaid. Version 31.1 will be in effect for dates of service April 1, 2025 – June 30, 2025. To access Gawenda Seminars outpatient therapy specific NCCI edit reference sheet for Medicaid, click HERE. There is one version for private practices and a different version for nonprivate practices. Be sure to be logged into your account.

Humana Medicaid has implemented a new claim processing edit for therapy services for the state of Indiana. In this article, I will answer the following questions

UnitedHealthcare Community Plan has published 2 Reimbursement Policies, one for providers who submit claims on a 1500-claim form (Professional) and one for providers who submit claims on a UB-04 claim form (Facility). The policies list which CPT codes are and are not covered by the different state’s Medicaid program. To access the policy for providers who submit claims on a 1500-claim form, click To access the policy for providers who submit claims on a UB-04 claim form, click I hope you found this article helpful to your practice or organization. Thank you for being a Gold Member!

Here are 2 updates regarding telehealth services being expanded to outpatient therapy services. Effective March 30, 2020, NC Medicaid is temporarily modifying its Telemedicine and Telepsychiatry Clinical Coverage Policy to better enable the delivery of remote care to Medicaid and NC Health Choice beneficiaries. These temporary changes will be retroactive to March 10, 2020, and will end the earlier of the cancellation of the North Carolina state of emergency declaration or when this policy is rescinded. Click HERE to read the special bulletin and its application to outpatient physical, occupational and speech therapy services. Blue Cross Blue Shield (BCBS) of North Carolina

The North Carolina Physical Therapy Association has provided updated Reimbursement and Practice Updates Related to the Covid-19 Pandemic. To access the update, click HERE.