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It Is Deja Vu ALL OVER AGAIN!!!
CMS has published the new NCCI Edits effective Oct 1, 2020 and they are reinstating some of the problematic code set edits that we saw in January of 2020 and they removed in April of 2020.
The APTA has sent a letter to CMS and the NCCI Edit Contractor asking them to remove these problem code edits OR to delay the implementation since they did not provide communication on these changes with any advance notice; however, there is no indication at this moment in time that they will make a change prior to the effective date.
Please see this communication for more details.
A summary of the primary changes affecting therapy are below: See the CMS Link for the Full List:
While traditional Medicare doesn’t usually have an issue with codes filed with a 59 modifier, other payers such as Humana (and some other Commercial Payers) have developed policies where they will deny any code with a 59 modifier and will only pay if they review the notes and determine that the notes support the codes billed.
Please be aware of these changes that will be effective Oct 1. Check with your EMR to see how they will handle these changes, and educate your staff. If they reverse course on this decision, we will let you know.
NCCI Edit Summary Effective Oct 1, 2020