CMS National Correct Coding Initiative edits, known as NCCI edits, provide guidelines for what codes can be billed with evaluation codes and which modifiers may be required. As you can imagine, these rules can greatly impact reimbursement.
In January, CMS implemented strict changes about what could and could not be billed with an evaluation code. Since then, CMS has rescinded many of their changes in order to alleviate the significant burden that the update to the edits placed on providers during COVID-19.
PTS in both private practice and rehab agencies can pair many codes without adding the 59 or applicable X modifier. These changes are retroactive to January 1, 2020.
The Coding Changes
PTs are now able to pair the following code combinations without the use of 59 or X modifiers:
97530 with 97116
97161 with 97140
97162 with 97140
97163 with 97140
99281-99285 with 97161-97168
97110 with 97164
97112 with 97164
97113 with 97164
97116 with 97164
97140 with 97164
97150 with 97110
97150 with 97112
97150 with 97116
97150 with 97164
There are additional edit changes as well that can be viewed on the CMS links below.
Which Payers These NCCI Edit Changes Apply to:
Medicare and Medicaid follow CMS’ NCCI edits. Commercial payers also typically follow the edit guidelines but may not have updated yet based on the recent news. It is important to check with your insurance companies if you have denials come back for the previous edit guidelines.
Links to Learn More:
https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/Version_Update_Changes