Medicare Deletes CCI Edit, Allows Same-Day Billing of Videofluoroscopic Swallowing Study by SLPs and Radiologists Without a Modifier

ASHA confirmed with the National Correct Coding Initiative (NCCI) contractor, Capitol Bridge, LLC, that the Centers for Medicare & Medicaid Services (CMS) deleted the new National Correct Coding Initiative (CCI) edit that prevented same-day billing of Current Procedural Terminology (CPT ® American Medical Association) codes 92611 (Motion fluoroscopic evaluation of swallowing function by cine or video recording) and 74230 (Radiologic examination, swallowing function, with cineradiography/videoradiography). With the deletion of the CCI edit, speech-language pathologists (SLPs) and radiologists may now report CPT codes 92611 and 74230 on the same day, for the same patient, without a modifier. ASHA appreciates the complete reversal of the incorrect edit by CMS, in line with ASHA’s original request, that reaffirms the important collaboration of SLPs and radiologists during the VFSS.

In an initial February 5, 2020, letter to ASHA, CMS noted that the new edit was changed to allow same-day billing of 92611 and 74230 with an NCCI associated modifier. However, based on a February 26, 2020, communication from Capitol Bridge and careful review of the newly updated CCI edits list posted on the CMS Medicare and Medicaid websites, ASHA confirms that the CCI edit for the code pair of 92611 and 74230 no longer exists.

With the latest updates to the CCI edit lists now available, Medicare Administrative Contractors (MACS)—which handle claims processing for their assigned jurisdictions—should begin updating their claims processing systems in recognition of the deletion. All claims submitted on or after January 1, 2020, that appropriately included 92611 and 74230 can be reprocessed, as originally submitted, for payment of 74230. Providers should contact their local MACs or other payers directly regarding their implementation timeline for the newly deleted edit and the appropriate steps for reprocessing or resubmitting claims for payment.

Background

The NCCI (or more commonly, CCI) 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. Other third-party payers may also adopt CCI edits, though they may modify them for their own purposes.

ASHA Resources

See CCI Edits for Speech-Language Pathology Services for additional information on same-day billing restrictions and related modifiers. For questions, please contact reimbursement@asha.org.