![]() 9 - A "9" indicator is used for all code pairs whose deletion date is the same as their effective date.Assuming the modifier is used correctly and appropriately, this specificity provides the basis upon which separate payment for the services billed may be considered justifiable. 1 - Indicates that a modifier is allowed in order to differentiate between the services provided.The services represented by the code combination will not be paid separately. ![]() 0 - Indicates that there are no circumstances in which a modifier would be appropriate.The modifier indicators are represented by (0), (1), and (9) and are shown after the code number on the NCCI edits tables. The CPT codes are suffixed with superscript numbers representing the CCI modifier indicator. An add-on code is eligible for payment only if one of its primary codes is also eligible for payment. Add-on code edits consist of a listing of HCPCS and CPT add-on codes with their respective primary codes.Practitioner MUEs are applied to all claims submitted by physical therapists, physicians, and other practitioners.ĭME Supplier MUEs are applied to claims submitted to DME MACs.įacility Outpatient MUEs are applied to all claims for types of bills identified as 13X, 14X, and 85X (critical-access hospitals). MUEs are divided into three provider types: An MUE for a HCPCS/CPT code is the maximum number of units of service under most circumstances able to be reported by the same provider for the same beneficiary on the same date of service. Medically Unlikely Edits (MUEs) prevent improper payment for an inappropriate number/quantity of the same service on a single day.PTP edits - Hospital are applied to claims submitted for services that are paid under the outpatient prospective payment system for example, outpatient hospital services, Part B skilled nursing facilities, comprehensive outpatient rehabilitation facilities, outpatient physical therapy and speech-language pathology providers, and certain claims for home health agencies billing under types of claims identified as 22X, 23X, 75X, 74X, and 34X. PTP edits - Practitioner are applied to claims submitted by physical therapists in private practice, as well as by other nonphysician practitioners and physicians, and by ambulatory surgery centers. The NCCI PTP edits are divided into two provider types: Each edit has a Column One and Column Two HCPCS/CPT code, called a "pair." If a provider reports the 2 codes of an edit pair for the same beneficiary on the same date of service, the Column One code is eligible for payment, but the Column Two code is denied unless a clinically appropriate NCCI-associated modifier is permitted and reported. NCCI PTP editprevent inappropriate payment of services that should not be reported together.PTP edits and MUEs are contained in a single table that includes the PTP code pairs that should not be reported together for a number of reasons, as explained in the NCCI coding policy manual. NCCI includes three types of edits: NCCI procedure-to-procedure (PTP) edits, medically unlikely edits (MUEs), and add-on code edits. (Note: It is important to check each commercial payer’s policy to determine if a payer adopts these changes and/or will allow reprocessing of denied claims.) A table with a list of the common physical therapy code pairs with PTP edits is at the bottom of this page. These changes are implemented in the Jan. For questions about reprocessing of denied claims please contact your Medicare Administrative Contractor or state Medicaid agency. The deletion of these edits is retroactive to Jan. In response to APTA’s requests for changes to edits that effect the delivery of appropriate physical therapy care CMS has deleted a number of edits that impact common physical therapy code pairs. APTA’s advocacy efforts to address problematic National Correct Coding Initiative Procedure-to-Procedure edits have had an impact.
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