NCCI Quarterly Edits Posted

AOTA wants to alert OT practitioners that the Centers for Medicare & Medicaid Services (CMS) has posted the October 1, 2020, changes to the National Correct Coding Initiative (NCCI) edits. As you may recall, in April, CMS deleted numerous NCCI edits affecting therapy evaluation and interventions codes. These deletions meant that the codes could be billed together on the same date of service without the addition of the 59 modifier.

In October, CMS is reinstating a number of those edits, once again requiring a 59 modifier to indicate the services were performed in separate time frames to receive proper payment. A worksheet with all of the NCCI additions and changes can be found on the CMS website. CMS has created detailed coding guidance on use of the 59 modifier that we encourage you to review. 

It is important to note that these changes are completely unrelated to the edits AOTA successfully fought to have removed in January that prohibited billing 97530 and 97150 with an evaluation. These changes revert to edits that have been in effect in previous years, and guidance on the edits can be found on AOTA’s NCCI table.

Any questions about the NCCI changes can be sent to regulatory@aota.org.

Note: On September 8, AOTA submitted a letter to CMS, advocating that the agency does not re-introduce these code edits during the public health emergency in light of the significant burden and confusion such a change would create for occupational therapy practitioners.