Medicare National Correct Coding Initiative (NCCI) edits for occupational therapy
The Medicare National Correct Coding Initiative (NCCI) (also known as CCI) was implemented to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Medicare Part B claims. NCCI Edits are updated quarterly to prevent improper payments when incorrect code combinations are reported.
The following NCCI Edits only apply to Medicare Part B services. State Medicaid agencies and other third party and commercial payers are also required to use CCI Edits but may modify them to meet their own programmatic needs. Please check with non-Medicare payers regarding their use of CCI Edits.
The following rules apply to the table below:
- Codes in Column 1 can never be billed together when attached to codes in Column 2 for the same patient on the same date of service when indicated with a “Not Allowed” designation.
- When applicable, codes in Column 1 can be billed together for the same patient on the same date of service in Column 2 by attaching the -59 modifier to bypass the code edit. The -59 modifier indicates that the two procedures are separate and distinct (the use of the modifier must be supported in the medical record).
- Modifier -59 should be attached to the CPT code listed in Column 2.
- The Practitioner Column 2 table should be used for CPT code combinations used for a clinical setting when the same practitioner treats the same patient on the same date of service.
- The Hospital Column 2 table should be used for CPT code combinations in a clinical setting when multiple practitioners (or different specialties) treat the same patient on the same date of service.
- For instance, if an OT and a PT treat the same patient on the same day.
Note: This is not a comprehensive list and includes code pairs typically billed by OT practitioners. A complete list of CCI Edits is available on the CMS website. To access the complete list go to https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html.