CMS Reinstates CCI Edits for Therapy Services

The Centers for Medicare & Medicaid Services (CMS) will reinstate several therapy code edits in its quarterly update of the National Correct Coding Initiative (NCCI or CCI) system, effective October 1, 2020. However, the reinstatement does not affect long-standing edits for procedure code pairs typically reported by speech-language pathologists (SLPs).

Earlier this year, CMS temporarily deleted certain CCI edits related to speech-language pathology services in conjunction with its expansion of telehealth services during the public health emergency. For example, the temporary changes allowed SLPs to report speech and language treatment (92507) and therapy for the use of a speech-generating device (92609) on the same day without a modifier, when a modifier is usually required for this code pair. The October 1 updates reverse all of these changes and clinicians should revert to the long-standing NCCI edits associated with speech-language pathology code pairs.

Background

The NCCI is an automated edit system to control specific procedure code pairs that can or cannot be reported on the same day. CMS developed the system for use in all Medicare Part B (outpatient) and Medicaid claims.

Resources

See ASHA’s CCI Edits for Speech-Language Pathology Services for a list of edits for SLPs, which reflects the long-standing edits that will go back into effect with the October 1 update.

See the CMS NCCI Quarterly Updates page for the complete list of edits.

Questions?

For more information, contact reimbursement@asha.org.