NCCI Edits and Modifier 59: Version 28.0

Rick Gawenda

Please join us as Gawenda Seminars & Consulting, Inc. presents “Understanding NCCI Edits and Modifier 59: Version 26.2” webinar conference on June 24, 2020 from 1:00PM – 2:00PM eastern daylight time. The Centers for Medicare and Medicaid Services (CMS) updates the National Correct Coding Initiative (NCCI) edits every quarter. This webinar will provide participants with information on NCCI Edits Version 26.2 that become effective on July 1, 2020. In addition, I will teach participants changes that occurred in April 2020 that went retroactive to either December 31, 2019 or January 1, 2020.  To register online with a credit card, purchase … Read More

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 … Read More

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!

NCCI Edits and Version 27.0

The Centers for Medicare and Medicaid Services (CMS) has released the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits Version 27.0 that will be effective with dates of service January 1, 2021 through March 31, 2021. CMS has deleted several of the NCCI PTP edits that they had reinstated for dates of service October 1, 2020 through December 31, 2020 that had a negative impact on outpatient physical, occupational and speech therapy services. NCCI PTP edits that CMS deleted that have an impact on outpatient therapy services include: In addition, CMS deleted the following NCCI PTP edits that impacted therapy … Read More

NCCI Edits: Questions and Answers

On June 15, 2020, I published an article where I answered some of the more common questions I receive regarding the National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits as they pertain to outpatient physical, occupational and speech therapy services. That article led to additional questions that I will provide answers to in this article. QuestionDoes the Medicare program pay for CPT code 97750 (Physical performance test or measurement) on the same day as a physical therapy or occupational therapy evaluation or reevaluation? Answer QuestionDoes the Medicare program pay for CPT code 97755 (Assistive technology assessment) on the same day … Read More

CMS Reinstates Therapy NCCI Edits

The Centers for Medicare and Medicaid Services (CMS) has reinstated many of the procedure-to-procedure (PTP) edits, known more commonly as the National Correct Coding Initiative (NCCI) edits, for physical therapy, occupational therapy, and speech therapy outpatient therapy services that they had deleted earlier this year. The reinstated NCCI edits were published by CMS on September 1, 2020 and become effective with dates of service beginning on October 1, 2020. CPT codes affected include, but are not limited to, the following: Biofeedback codes (CPT codes 90912 and 90913) Speech therapy evaluations (CPT codes 92521-92524) Speech therapy treatment and treatment of dysphagia … Read More

Aetna to Reactivate Billing Modifiers 25, 59 and X series

Aetna has announced they will reactivate edits when a CPT code on the claim form contains billing modifiers 25, 59 or X series (XE, XP, XS, XU). This reactivation will apply to the states of I hope you found this article helpful. Thank you for being a Gold Member!

NCCI Edits and Version 26.2

The Centers for Medicare and Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) edits to combat improper coding that would then lead to inappropriate payment in Medicare Part B claims. CMS owns the NCCI program and is responsible for all decisions regarding its contents. Capital Bridge, LLC is CMS’ contractor for the NCCI. In this article, I will answer some of the more common questions I receive concerning NCCI edits. In addition, I will be presenting a webinar on June 24, 2020 titled “Understanding NCCI Edits & Modifier 59: Version 26.2“. This webinar will provide participants with information on … Read More