Wednesday, February 19, 2020

CMS Rescinds Troublesome NCCI Medicare Part B Therapy Claim Edits Retroactive to 1/1/2020

Dan Ciolek

After an advocacy effort conducted by AHCA/NCAL and other organizations, CMS has rescinded eighteen problematic National Correct Coding Initiative (NCCI) Edits retroactive to January 1, 2020 that would have prohibited payments for Medicare Part B Physical Therapy (PT) and Occupational Therapy (OT) evaluations on the same day that Therapeutic Procedures or Group Therapy common procedural terminology (CPT) billing codes were billed on a claim.  In early January, AHCA/NCAL posted a fact sheet for members describing the issue.  On January 24, the CMS NCCI edit development contractor sent this letter to AHCA describing the policy reversal, and this follow-up letter on February 5 that includes additional details about what to do if providers submitted claims prior to this reversal that were denied due to the edits.  The current accurate NCCI edit tables effective January 1, 2020 are available here.   

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