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12/12/22

NCCI Edits Version 29.0

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

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09/07/21

NCCI Edits Version 27.3 Effective October 1, 2021

The Centers for Medicare and Medicaid Services (CMS) has published the National Correct Coding Initiative (NCCI) edits, Version 27.3, for dates of service October 1, 2021 – December 31, 2021. These NCCI edits are not only used by traditional Medicare, but also by many state Medicaid and Managed Medicaid plans as well as many commercial insurance carriers and workers compensation insurance carriers. As Gawenda Seminars & Consulting (GSC) has done every quarter for their Gold Members, GSC has published their “cheat sheet” for the use of modifier 59 in outpatient therapy under NCCI edit Version 27.3. This “cheat sheet” includes

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02/22/21

NCCI Edit Changes for Aetna, Cigna and Humana

Aetna, Cigna and Humana have all announced changes to their respective policies related to the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits and the payment of a CPT code(s) that has had modifier 59 appended to it on the claim form. These positive changes would not have occurred without the advocacy of the American Physical Therapy Association (APTA). Aetna Aetna has informed Cigna According to Humana Humana has informed I hope you found this article and information helpful. Thank you for being a Gold Member!

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