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...

Article

CMS Updates Guidance to Reflect Current Plan of Care Signature Exception

Dec 3, 2025

A recent U.S. Centers for Medicare & Medicaid Services’ MLN Matters update provided guidance on a range of topics, including the plan of care signature

News

APTA Advocacy Win: Anthem Changes Payment Policy to Document Total Time per Code

Sep 24, 2025

After advocacy efforts from APTA staff and members, Anthem has changed its reimbursement policy so that PTs are no longer required to document start and

News

APTA Advocates Against Anthem's Policy for Reporting Timed Units

Jul 9, 2025

APTA urges the insurer to revise the policy and has created a template letter for members to add their voices to the advocacy effort.