CMS Rescinds Several Problematic Outpatient Therapy NCCI Edits

​​​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AHCA/NCAL and other organizations, Effective January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) has rescinded twenty-one problematic National Correct Coding Initiative (NCCI) edits impacting outpatient therapy services.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.

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