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)

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!

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!

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! 

The Centers for Medicare and Medicaid Services (CMS) have implemented National Correct Coding Initiative (NCCI) edits version 26.0. NCCI edits version 26.0 is in effect for dates of service January 1, 2020 – March 31, 2020. One significant change with this version involves a speech-language pathologist (SLP) and a radiologist collaborating to perform a motion fluoroscopic evaluation of swallowing function by cine or video recording (modified barium status study). Effective with NCCI version 26.0, CPT code 74230 (Radiologic examination, swallowing function, with cineradiography/videoradiography) will not be To access the current version of NCCI edits specific to outpatient therapy services, click

Effective with dates of service on and after January 1, 2020, the Centers for Medicare and Medicaid Services (CMS) will Question Is there a “work-around” to this issue? Answer Question Can I count the evaluation time under therapeutic activities? Answer Question Can I provide other treatments the same day as an evaluation? Answer Question Do these NCCI edits apply to all insurance carriers, including Medicare Advantage plans Answer Question Can any insurance carrier, Medicaid plan or Medicare Advantage plan implement the NCCI edits? Answer Question How do I know if an insurance carrier, Medicaid plan or Medicare Advantage plan has

For dates of service on and after July 1, 2019, the Centers for Medicare and Medicaid Services (CMS), as well as UnitedHealthcare (UHC), is changing which CPT code Modifier 59 must be appended to on the claim form in order for both the Column 1 and Column 2 CPT codes to be paid when provided on the same date of service. If you missed my webinar last week on NCCI edits and Modifier 59, click HERE to see the complete webinar description, objectives and to order the recorded version with handouts and Gawenda Seminars & Consulting NCCI edit reference sheet.

A question I often receive is can I bill and be paid for an evaluation or reevaluation (CPT codes 97161-97168) and a physical performance test and measurement (CPT code 97750) when provided on the same date of service by the same discipline? To obtain the answer, we must refer to the