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

The Centers for Medicare and Medicaid Services (CMS) has announced a significant change to the use of modifier 59, XE, XP, XS and XU effective July 1, 2019. Currently, the multi-carrier system (MCS) claims system processing logic for modifier 59, XE, XP, XS and XU be appended to the column two CPT code of a procedure to procedure (PTP) edit in order to bypass the edit and allow both CPT codes to be paid by the Medicare Administrative Contractor (MAC). Beginning with dates of service on and after July 1, 2019, the CMS will Click HERE to view the latest

CMS would like to announce that on February 1, 2019, the National Correct Coding Initiative (NCCI) Medicare and Medicaid Program Contract was awarded to a new contractor, Capitol Bridge LLC (2300 9TH STREET, SOUTH, PH3 ARLINGTON, VA 22204 Congressional District: VA-08). The incumbent contractor, CCS WP LLC/Correct Coding Solutions LLC and its principles will be retiring on March 16, 2019, immediately after the transition period with Capitol Bridge LLC. The transition period started on February 3, 2019, and will end on March 15, 2019. Please continue to send all correspondence to CCS WP LLC/Correct Coding Solutions LLC until March 14,

The National Correct Coding Initiative (NCCI) edits Version 25.0 has been released and is in effect for dates of service January 1, 2019 – March 31, 2019. There are many changes in this version due to the 2019 new and deleted CPT codes. There are several new CPT codes related to Adaptive Behavior as well as Developmental Testing. To access the NCCI Edit Version 25.0 “cheat sheet” applicable to physical therapy, occupational therapy and speech-language pathology services, click HERE. Thank you for being a Gold Member!