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09/29/20

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

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09/08/20

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

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09/01/20

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!

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06/15/20

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

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04/21/20

NCCI Edits and Major Changes

National Correct Coding Initiative (NCCI) edits are updated quarterly by the Centers for Medicare and Medicaid Services (CMS) and Capital Bridge, CMS’ NCCI coding contractor. Updates occur on January 1, April 1, July 1, and October 1 of each calendar year. Typically, the January 1 update sees the most additions, deletions and revisions due to new, revised and deleted CPT codes taking effect on January 1 of the calendar year. Due to the COVID-19 Public Health Emergency as well as CMS’s expansion of telehealth services, CMS updated procedure-to-procedure (PTP) edits and Medically Unlikely Edits (MUEs) for Current Procedural Terminology (CPT)

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02/24/20

Billing CPT Codes 92611 and 74230 Same Day: Update

The Centers for Medicare and Medicaid Services (CMS) and Capital Bridge, LLC, who is the National Correct Coding Initiative (NCCI) contractor, has informed the American Speech-Language-Hearing Association (ASHA) that they will change the modifier indicator for when CPT codes 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording) and 74230 (Radiologic examination, swallowing function, with cineradiography/videoradiography) are billed on the same date of service by the same provider. CMS will now assign a modifier indicator ofI hope you found this article informative. Thank you for being a Gold Member!

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02/09/20

UnitedHealthcare to Implement NCCI Edits

UnitedHealthcare (UHC) has announced they will implement the National Correct Coding Initiative (NCCI) edits to outpatient physical, occupational and speech therapy services effective with dates of service on and after I hope you found this article informative and will assist you in notifying your staff, billing company or billing department about this upcoming change that will impact your payment for outpatient therapy services if unaware of this change. Thank you for being a Gold Member!

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01/24/20

Update on Evaluation and Therapeutic Activities Same Day

Breaking news from the Centers for Medicare and Medicaid Services (CMS) regarding the payment of a physical therapy evaluation and/or occupational therapy evaluation on the same day you bill therapeutic activities. Several professional organizations have received notice from Capital Bridge, LLC, National Correct Coding Initiative Contractor, announcing they will What About Group Therapy and an Evaluation on the Same Day? What About Manual Therapy and an Evaluation Same Day? I hope you found this information helpful. Thank you for being a Gold Member! 

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