CMS Reinstates Outpatient Therapy NCCI Edits

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 codes (92507 and 92526)
• Evaluation for a speech generating device (92607)
• Programming and training for speech generating device (92609)
• Physical and occupational therapy evaluations and reevaluations (CPT codes 97161- 97168)
• Aquatic therapy
• Therapeutic activities
• Assistive technology assessment
• Orthotic management and training
• Prosthetic training

In addition, with CMS reinstating many of the NCCI edits, most likely, this will have a negative impact on outpatient therapy providers who submit claims to Aetna, Anthem BC, Humana and others who do not pay the column 2 CPT code when billed on the same day as the column 1 CPT code even when the provider appends modifier 59 correctly.

To access Gawenda Seminars & Consulting NCCI edit reference sheet that provides the physical, occupational and speech therapy NCCI edits in an easy-to-read format, click HERE.

In addition, I'll be doing a webinar on September 30, 2020 where I will will provide participants with information on NCCI Edits Version 26.3 that become effective on October 1, 2020. Click HERE for additional information and to register for this webinar.