Claims Processing Issues Log

Here is a list of current system-related claims payment and processing issues. These issues have been reported to the Centers for Medicare & Medicaid Services (CMS) and/or the Multi-Carrier System (MCS). Please check often for updates before contacting the provider contact center. The issues are identified by stand alone articles and will be updated as needed.

NCCI Procedure-to-Procedure (PTP) Edit Replacement Files

NCCI Procedure-to-Procedure (PTP) Edit Replacement Files
Current Status
Date
 
Initial
2/18/2020
Status: CMS has provided Medicare Administrative Contractors with a replacement PTP file. Palmetto GBA will adjust affected claims within 30 business days.  
Provider Action: No provider action is required at this time.
Date Identified
2/5/2020
Issue 

The Centers for Medicare & Medicaid Services (CMS) issued the following directive: CMS will retroactively delete procedure-to-procedure (PTP) edits for the following physical therapy codes/coding pairs for services provided on or after January 1, 2020.

Column 1 / Column 2 CPT Codes
Column 1 / Column 2 CPT Codes
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
97150/97172
97530/97172

CMS has provided Medicare Administrative Contractors with a replacement PTP file. Palmetto GBA will adjust affected claims within 30 business days.  

Please notify me when this article has been updated.

This was last updated on 02/19/2020

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