The Centers for Medicare and Medicaid Services (CMS) has reinstated many of the procedure-to-procedure (PTP) edits, known more commonly as the National Correct Coding Initiative (NCCI) edits, for physical therapy, occupational therapy, and speech therapy outpatient therapy services that they had deleted earlier this year. The reinstated NCCI edits were published by CMS on September 1, 2020 and become effective with dates of service beginning on October 1, 2020. CPT codes affected include, but are not limited to, the following: Biofeedback codes (CPT codes 90912 and 90913) Speech therapy evaluations (CPT codes 92521-92524) Speech therapy treatment and treatment of dysphagia

The Centers for Medicare and Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) edits to combat improper coding that would then lead to inappropriate payment in Medicare Part B claims. CMS owns the NCCI program and is responsible for all decisions regarding its contents. Capital Bridge, LLC is CMS’ contractor for the NCCI. In this article, I will answer some of the more common questions I receive concerning NCCI edits. In addition, I will be presenting a webinar on June 24, 2020 titled “Understanding NCCI Edits & Modifier 59: Version 26.2“. This webinar will provide participants with information on

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)

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!

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

Every quarter, the Centers for Medicare and Medicaid Services (CMS) updates the National Correct Coding Initiative (NCCI) edits. This occurs on January 1st, April 1st, July 1st and October 1st of every year. The biggest changes usually occur with the January 1st edition due to new and deleted CPT codes for the new calendar year now being in effect. Version 26.0 has been released by CMS. This version will be effective with dates of service beginning on January 1, 2020 through March 31, 2020. There are many additions and deletions to Version 26.0 that will have a significant impact on

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.