Skip to main content

The U.S. Centers for Medicare & Medicaid Services' National Correct Coding Initiative has noble intentions — namely, to minimize improper coding that leads to improper payment under Medicare Part B and Medicaid. But sometimes even the best intentions can do more harm than good.

That's what happened in January of 2020, when CMS unveiled so-called "edits" to several common pairings of current procedural terminology codes frequently used on the same day by PTs. The edits severely restricted use of the code pairings by either requiring the use of the 59, X, XE, XP, XS, or XU modifiers — or by prohibiting the pairing completely.

APTA fought back. Ultimately, CMS dropped many of the edits, and PTs can bill many pairs of codes for services delivered on the same day without the use of a modifier.

Here are four things to know about where things stand with the NCCI edits and physical therapy.

Log in or create a free account to keep reading.


Join APTA to get unlimited access to content.


You Might Also Like...

Resource

APTA Payment & Regulatory Update Series

Dec 2, 2021

Stay updated with payment and regulatory topics that provide you with the latest and most pressing payment and regulatory issues, as well as pose questions

News

Beginning Oct. 1: Stop Using This ICD-10 Code for LBP

Sep 29, 2021

In a continuing press for codes that are more specific, a single, general LBP code has been replaced with several.

Article

Identifying the Correct Codes for ICD-10

Sep 24, 2021

Access guidelines and information on how to identify the correct codes for ICD-10.