“Can we bill these 2 codes together?”
“Is modifier 59 required?”
“Will Medicare Part B pay for these therapy services?”
Knowing what Current Procedural Terminology (CPT) Codes can and cannot be billed together, and when a modifier is required for payment are a few of the many, many, many rule sets SNF therapy professionals need to master. These code combinations or “edits” are near and dear to therapy professionals, put in place by the Center for Medicare and Medicaid Services (CMS) to control improper coding which can lead to inappropriate Medicare Part B billing.
CMS releases updated National Correct Coding Initiative (NCCI) edit decisions quarterly. CPT codes used by therapy professionals typically don’t see frequent changes in the edits. However, CMS has made quite a few changes over the past 2 years, with the most recent changes effective for therapy services provided on or after January 1, 2022.
What Is New for 2022?
CMS has now added the ability for manual therapy (97140) to be billed on the same day as the multi-layer compression system codes 29581 (LE compression foot to knee), 29582 (LE compression foot to thigh), 29583 (UE compression, upper arm/forearm) and 29584 (UE compression, fingers to upper arm). With use of the 59 modifier to identify that manual therapy techniques and compression wrapping were performed at separate distinct intervals, both codes will be reimbursed.
CMS has also included the Remote Therapeutic Monitoring (RTM) codes effective 1/1/22, indicating that in the SNF setting, 98981 – Treatment Management: subsequent 20 minute intervals per month, cannot be billed with 97750 – Physical Performance Tests and Measures. The private practice setting has an additional code combination exclusion in this group.
It is important to point out that there are some differences between the edits, code combinations and modifier requirements used by practitioners in private practice and the SNF setting.
“Practitioner” rules refer to private practice practitioners who bill Medicare directly. The SNF setting falls under “Outpatient Hospital Services” rules, referring to the group of settings that bill Medicare Part B, including SNF Part B, CORF, and Home Health Agencies, on the following bill types:
- 22x (SNF Part B residents)
- 23x (SNF Outpatient – Non-residents)
- 75x (Comprehensive Outpatient Rehab Facility)
- 74x (Outpatient Rehab Facility)
- 34x (Home Health Agency)
Updated NCCI Edit Cheat Sheets Available
Who likes reviewing over half a million rows of CPT codes to pick out the edit combinations for therapists??
Not you? We didn’t think so, so we did the digging for you and created 2 cheat sheets:
- Private Practice
- SNF Part B, CORF, ORF, HHA
Here is a sample of the cheat sheet:
To access the document for download, go to the Therapist Toolbox – Medicare Part B Section and select NCCI Edits. Or CLICK HERE. Make sure you are logged in for access. The PDF’s can be printed or saved to your computer.
This is the Toolbox you are looking for….the NCCI cheat sheets can be found at the 3rd bullet point.
Here are additional resources for your exploration:
NCCI Excel Tables – Explore all the code combinations yourself!
NCCI Instruction Guide from CMS.
As always, if you have any questions, please send them to our Just Ask Q&A team and we will be glad to help you.
In your corner,
Dolores Montero, PT, DPT, RAC-CT, RAC-CTA
SNF Rehab & MDS Resource Team | www.MonteroTherapyServices.com