CMS Posts January 2021 Quarterly Update to NCCI PTP Edits

CMS Posts January 2021 Quarterly Update to NCCI PTP Edits

The January 2021 quarterly update to the National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) Edits were posted on CMS’ website the week of December 1st. CMS again made several significant changes that impact physical, occupational, and speech therapy services. After the October 2021 quarterly update that reinstated a multitude of edits that had been deleted earlier in the year, therapy professional associations reached out to Capitol Bridge, CMS’ NCCI contractor, advocating for the removal of edits that go against best practice from a clinical perspective and have forced overutilization of modifier 59. CMS responded by deleting multiple code pairs in both hospital and office settings. Interestingly, these changes are retroactive – some to 10/1/2020, some back to 12/31/2019.

A few of the notable deletions include:

        • 97110, 97112, 97113, 97116, 97140, 97150, and 97530 with 97164 and 97168
        • 97530 with 97113 and 97116
        • 97161-97163 and 97165-97167 with 97140
        • 97140 with 97530
        • And 99281-99285 with 97161-97168

The APTA has reached out to CMS and Capitol Bridge for clarifications on the deletion dates and any guidance or provisions regarding reprocessing of any previously denied claims. Providers should also watch for any updates or changes to commercial payer billing policies and practices with respect to the application of modifier 59 or the more descriptive X{EPSU} modifiers.

For more information, access the current NCCI PTP edit tables here.

Holly Hester

Holly Hester is Casamba’s Senior Vice President of Compliance & Education, as well as the Compliance Officer. She provides regulatory guidance and interpretation, clinical programming and content development, education and training steerage, and compliance support for the company. As a physical therapist for more than 20 years, Holly has multi-venue clinical and management experience, giving her a unique perspective on the integration of compliance and training with therapy service delivery and clinical practice.
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