An unexpected announcement has been made 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 both physical occupational therapy. CMS announced it will no longer allow two frequently used therapy billing codes to be used in combination with evaluation codes. According to both AOTA and APTA, 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.
Visit the below websites to read more on this issue and join us in taking action on this change!
NARA is also asking it’s members to use this letter to submit to the CMS contractor who handles the CCI Edits.
In order to view the full list of edits that went into effect January 1, visit the CMS PTP coding edits webpage. Scroll to the bottom of the page for “related links”. There you can select your setting to find how this affects your area of practice.