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CMS Reinstates Modifier 59 with October 2020 NCCI PTP Update

CMS Reinstates Modifier 59 with October 2020 NCCI PTP Update

CMS updates the NCCI Procedure to Procedure (PTP) edit tables for physicians/practitioners and hospitals quarterly every January, April, July and October. In April of this year, CMS made significant changes to these edits, removing many long-standing code pairings for PT, OT and SLP that historically required the application of modifier 59 (for example, 97530 and 97116).  At that time, CMS announced they were updating the edits in response to the COVID-19 Public Health Emergency and the expansion of telehealth services. In July, these changes remained in place. With the October update, the changes (that is, the deletions) made in April have been reversed, and the edits are being reinstated with an effective date of October 1, 2020.

Access the list of changes outlined in the October update, click here.

Access the updated NCCI PTP edit tables, click 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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