AOTA Opposing Changes to NCCI Edits Effective January 1, 2020

In late December, AOTA became aware that the Centers for Medicare & Medicaid Services (CMS) accepted two changes to the National Correct Coding Initiative (NCCI) edits effective January 1, 2020 that affect occupational therapy. Therapeutic activities (97530) and therapeutic procedures, group (97150) can no longer be billed on the same day as an occupational therapy or physical therapy evaluation. These are hard edits, and a modifier 59 will not get the services paid.

These changes came as a surprise because Capitol Bridge, LLC, the company in charge of NCCI edits, did not give AOTA or APTA advance notice of the changes. AOTA has contacted Capitol Bridge requesting that these changes be removed.

Although changes to NCCI edits are effective quarterly, AOTA is advocating for an earlier correction to the NCCI edits on 97530 and 97150.

AOTA encourages practitioners to send comments about the change in edits to Capitol Bridge, LLC at NCCIPTPMUE@cms.hhs.gov.

Template Email Letter for Comments

Use the template email letter to submit your comments. Be sure to make your letter stronger by adding personal clinical examples of where performing therapeutic activities on the same day as an evaluation has provided continuity of and access to quality care.

1-31-2020 Update to National Correct Coding Initiative Edit Changes