The National Correct Coding Initiative (NCCI) Edits Version 31.2 are in effect for dates of service July 1, 2025 – September 30, 2025. 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

The Centers for Medicare and Medicaid Services (CMS) has released the National Correct Coding Initiative (NCCI) edits Version 31.1 for original Medicare. Version 31.1 will be in effect for dates of service April 1, 2025 – June 30, 2025. To access Gawenda Seminars outpatient therapy specific NCCI edit reference sheet for original Medicare, click HERE. There is one version for private practices and a different version for nonprivate practices. Be sure to be logged into your account.

The Centers for Medicare and Medicaid Services (CMS) has released the National Correct Coding Initiative (NCCI) edits Version 31.1 for original Medicaid. Version 31.1 will be in effect for dates of service April 1, 2025 – June 30, 2025. To access Gawenda Seminars outpatient therapy specific NCCI edit reference sheet for Medicaid, click HERE. There is one version for private practices and a different version for nonprivate practices. Be sure to be logged into your account.

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) 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.