Palmetto GBA Provides Update on CCI Edits

Feb 21

Palmetto GBA has published communication to providers regarding the NCCI Procedure-to-Procedure (PTP) Edit Replacement Files.  To review, CMS announced in January that it would resolve the recent problematic CCI edits related to the therapy evaluation codes (97161, 97162, 97163, 97165, 97166, and 97167) when billed on the same day as therapeutic activity (97530) or group therapy (97150).  CMS notified providers that the Medicare Administrative Contactors (MACs) had been instructed to implement the replacement edit files and make the necessary claim adjustments.  Palmetto’s notification, published on February 19th and available here, stated affected claims would be adjusted within 30 business days and that no provider action is required at this time.   Additional updates will be shared from the other MACs as they are published.