The National Correct Coding Initiative (NCCI) Edits Version 32.2 are in effect for dates of service July 1, 2026– September 30, 2026. NCCI edits are used in all outpatient therapy settings for original Medicare and Medicaid beneficiaries. In addition, some Medicare Advantage plans, commercial insurers, and workers compensation programs also utilize the NCCI edits. Gawenda Seminars & Consulting has created a NCCI Edit therapy specific reference sheet for both Medicare and Medicaid. These reference sheets will inform providers when modifier 59 is required on a CPT code on the claim form. In addition, the reference sheet will inform providers what combination of

The National Correct Coding Initiative (NCCI) edits Version 30.3 are effective with dates of service October 1, 2024 – December 31, 2024. As a Gold, Platinum, or Diamond Member to my website, you have access to our NCCI Edit “cheat sheet” for modifier 59 that is specific to outpatient physical, occupational, and speech therapy services. To access NCCI Edits Version 30.3 for Medicare, click HERE and log into your account. To access NCCI Edits Version 30.3 for Medicaid, click HERE and log into your account.

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