NCCI Edits

NCCI Edits

CMS issued a NCCI edit stating that any PT or OT evaluation along with CPT codes 97530 and 97150 would be subject to deny as of January 1, 2020 if performed together on the same treatment day.  In late February of 2020, CMS retracted this NCCI edit and issued a statement to outpatient therapy providers that the NCCI edit would not be enforced for calendar year 2020 and all Medicare part B claims would be reprocessed by each facility MAC starting April 2020.  Due to the Coronavirus, CMS was unable to get the systems in place to retrieve any denied service lines for this specific NCCI edit in a timely fashion and in May 2020 CMS stated that all MAC’s would be reprocessing the claims with denied service lines no later than October 2020.  My advice for providers would be to keep track of all claims with the NCCI edits and place notes on each claim account as well as keep checking for updates from your MAC regarding the edit reprocessing.

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