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...

Review

Proposed FY '22 IRF Rule: 2.2% Increase; Call for Input on Equity, Reporting

Apr 13, 2021

As the U.S. health care system continues to struggle with a pandemic and its fallout, CMS keeps IRF payment changes relatively minimal.

Article

Coding for Timed Codes

Mar 22, 2021

Over the years there has been much confusion over the coding of minutes when billing private payers. APTA recommends billing be consistent to all payers.

News

CMS To Begin Recovering Money From Providers Who Received COVID-19 Loans

Mar 17, 2021

Time is up on the moratorium on recoupment for funds received through the Accelerated & Advance Payment program.