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  • CMS Coding Reversal Update: Providers Can Start Checking in With MACs

    It's official: Medicare Administrative Contractors for CMS have been notified of the agency's decision to reverse coding methodology decisions that prevented PTs from billing an evaluation and therapeutic activities or group therapy activity delivered on the same day, and to apply that decision to claims made back to the beginning of the year. The announcement means that providers can begin resubmitting or appealing claims that were denied while the now-defunct system was in place — but the contractor responsible for coding implementation says to check with your Medicare Administrative Contractor first.

    In a February 5 communication to APTA, Capitol Bridge LLC stated that CMS had "instructed the Medicare Administrative Contractors [known as MACs] to implement the replacement edit files and make claim adjustments," and announced that those replacement files are now available on both the Medicare Procedure-to-Procedure coding updates webpage and the Medicaid National Correct Coding Initiative Edit Files webpage. Capitol Bridge is the CMS contractor for the National Correct Coding Initiative, or NCCI.

    "Providers may check with their MAC about claim adjustments, appeal claims denied due to the [Procedure-to-Procedure, or PTP] edits to the appropriate MAC, or resubmit claims due to the PTP edits after implementation of the replacement edit file with January 1, 2020, retroactive date, as permitted by the MAC," Capitol Bridge writes. It advises providers to contact their MAC with questions about individual claims.

    APTA regulatory affairs staff will remain in communication with CMS and the NCCI contractor on the change and will share any new information that becomes available. For additional information, visit APTA’s webpage on the NCCI.