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.

Please join us as Gawenda Seminars & Consulting, Inc. presents “Understanding NCCI Edits and Modifier 59: Version 26.2” webinar conference on June 24, 2020 from 1:00PM – 2:00PM eastern daylight time. The Centers for Medicare and Medicaid Services (CMS) updates the National Correct Coding Initiative (NCCI) edits every quarter. This webinar will provide participants with information on NCCI Edits Version 26.2 that become effective on July 1, 2020. In addition, I will teach participants changes that occurred in April 2020 that went retroactive to either December 31, 2019 or January 1, 2020.  To register online with a credit card, purchase

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

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!

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.

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!

The Centers for Medicare and Medicaid Services (CMS) has released the National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits Version 27.0 that will be effective with dates of service January 1, 2021 through March 31, 2021. CMS has deleted several of the NCCI PTP edits that they had reinstated for dates of service October 1, 2020 through December 31, 2020 that had a negative impact on outpatient physical, occupational and speech therapy services. NCCI PTP edits that CMS deleted that have an impact on outpatient therapy services include: In addition, CMS deleted the following NCCI PTP edits that impacted therapy

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