CMS Rescinds Several Problematic Outpatient Therapy NCCI Edits

Medicare; CMS
​​​Subsequent to the advocacy efforts of AHCA/NCAL and other organizations, Effective January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) has rescinded twenty-one problematic National Correct Coding Initiative (NCCI) edits impacting outpatient therapy services. This includes services furnished under Medicare Part B for physical therapy (PT) and occupational therapy (OT) services.  

These code edits were previously implemented on October 1, 2020 and required additional documentation and claim modifier coding burden when procedure codes representing many PT or OT evaluation codes or treatment codes performed under a PT, OT, or speech-language pathology (SLP) plan of care was billed on the same date. This additional burden is no longer required.  

The complete listing of the quarterly NCCI edit change files is located on this page. The specific change file applicable to SNF services posted in December 2020 is here.      

The following table lists the 21 code edit combinations represented by the Column 1 and Column 2 that were removed, effective January 1, 2021. All other existing NCCI edits impacting SNF therapy services remain in place. Providers are encouraged to forward this information to therapy and billing staff.
​​​​​
Column 1Column 2Modifier
Indicator
0=not allowed
1= allowed
9= not applicable
97110971649
97110
971689
97112
971649
97112971689
97113971649
9711397168
9
97116971649
97116971689
97140971649
97140971689
97150971649
97150971689
97161971409
97162971409
97163971409
97165971409
97166971409
97167971409
97530971169
97530971649
97530971689