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03/28/22

NCCI Edits Version 28.1 Effective April 1, 2022

National Correct Coding Initiative (NCCI) Edits Version 28.1 are effective with dates of service April 1, 2022 – June 30, 2022. To access Gawenda Seminars & Consulting, Inc. therapy specific NCCI edit reference sheet that will assist you in determining whether modifier 59 is required or not, click HERE.

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09/07/21

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

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05/10/21

UnitedHealthcare Oxford Issues New NCCI Edit Policy

UnitedHealthcare Oxford has published a new reimbursement policy on National Correct Coding Initiative (NCCI) edits that is applicable for therapy providers who submit claims on a 1500-claim form. The effective date of this new policy is I hope you found this information helpful. Thank you for being a Gold Member!

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04/17/21

UnitedHealthcare Commercial Reimbursement Policy Updates

Effective with dates of service on or after 9/1/2020, the Outpatient Hospital Correct Coding Initiative (CCI) Editing policy will apply to all network and non-network hospitals. In addition, the policy will apply to all outpatient types of bills that are applicable to these edits. Click HERE to read the announcement straight from UnitedHealthcare.

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02/22/21

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!

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