The Centers for Medicare and Medicaid Services (CMS) will not be releasing a 2023 second quarter NCCI edits update. CMS has instructed Medicare Administrative Contractors as well as suppliers and providers of outpatient therapy services to continue to use the 2023 1st quarter NCCI edits until they release the 2023 3rd quarter NCCI edits. To access the 2023 1st quarter NCCI edits specific to outpatient therapy, click HERE.

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.

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

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.

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,