Thanks to your advocacy, a January 1, 2020, NCCI edit has been rescinded. This edit caused lower payment when certain common physical therapy codes were claimed on the same day.
What does this mean?
On January 1, 2020, a government contractor charged with eliminating overlapping payment within Medicare published an edit that immediately changed the way that certain commonly used codes were reimbursed. CMS and the contractor listened and sent a letter to confirm the rescission of the edit. It should be noted that the contractor did not rescind all of the edits it made, but evaluation codes 97161-97168 should now be paid when claimed on the same day with codes 97150 and 97530.
What should APTA Virginia members do?
The APTA Private Practice Section recommends that if you have been holding claims that include these codes, now is the time to submit them. If you submitted claims that complied with the edit, please consider re-filing them including all appropriate codes if your documentation supports the care delivered on the date of service. Thank you again. This change would not have taken place without the collective advocacy of physical therapists.