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.