NCCI Procedure-to-Procedure (PTP) Edit Replacement Files Effective January 1, 2020

NCCI Procedure-to-Procedure (PTP) Edit Replacement Files Effective January 1, 2020
Current Status
Date
 
Update
July 10, 2020
Status: At this time, all adjustments have not been completed.  A completion date will be communicated once all adjustments are made.  There is no need for providers to contact the provider contact center (PCC) for a status.  
 Resolved
May 7, 2020 
Status: Resolved 5/7/2020. Adjustments for claims affected by updates to the Procedure-to-Procedure Edits have been completed.
Initial
April 20, 2020
Status: Healthcare Common Procedure Coding System (HCPCS) codes G2029, G2030 and G0231 have been replaced with G2061, G2062 and G2063 respectively, effective January 1, 2020.
Claim adjustments began on April 6, 2020, for claims that received line item reason code W7020, and modifier GN, GO or GP, with dates of service on or after January 1, 2020, that contain one of the following HCPCS pairs:

97150 97161  97530 97161
97150 97162  97530 97162
97150 97163  97530 97163
97150 97165  97530 97165
97150 97166  97530 97166
97150 97167  97530 97167
97150 97169  97530 97169
97150 97170  97530 97170
97150 97171  97530 97171
97150 97530  97530 97172
Provider Action: No action is necessary. Adjustments will be completed within 90 days from April 6, 2020. There is no need for providers to contact the provider contact center (PCC) regarding this matter.
Identified Date
2/05/2020
Issue 
On January 1, 2020, CMS changed some of its correct coding methodologies in ways that prevented physical therapists (PTs) from billing an evaluation and therapeutic activity and/or group therapy services delivered on the same day. PTs will be able to bill for therapeutic activities (97530) delivered on the same day to the same patient as PT or occupational therapy evaluations. PTs (and occupational therapists) will also be allowed to return to billing the group therapy code (97150).   

Article Update Notification
Please notify me when this article has been updated.

Would you like to know when this article is updated? Sign up for Article Update Notifications below and we'll send you an email with the new version automatically.

Please check your spam/junk folder as your notification email maybe delivered there.

Email Address:
Please enter this four-digit number in the CAPTCHA Code field: 6796