CMS Clears Up Error in Description of Which CPT Code Combinations Won’t Receive Full Payment

CMS Clears Up Error in Description of Which CPT Code Combinations Won’t Receive Full Payment

Apparently, physical therapists (PTs), occupational therapists (OTs), and the outpatient facilities they work for aren’t the only ones adjusting to the new Current Procedural Terminology (CPT) tiered coding set: recently, the Centers for Medicare and Medicaid Services (CMS) informed APTA that it’s revising its National Correct Coding Initiatives “procedure to procedure” edits, a long list of CPT code pairs that should not be reported together. That list of problematic paired codes included PT and OT evaluation and reevaluation codes.

It’s a complicated situation, but the bottom line is, CMS is making changes that should allow for full payment of PT and OT evaluation and reevaluations code combinations that previously resulted in erroneous payment denials or partial payment when the new code set was first adopted in January. Ironically enough, it appears the change is an attempt by CMS to correct an error in its National Correct Coding Initiative. Here’s a breakdown.

Full story of the new Current Procedural Terminology (CPT) tiered coding set at APTA

ByFlex Therapist

FlexTherapist CEUs provides professional online training to Physical Therapists and Physical Therapist Assistants. Our courses are approved by boards throughout the United States for CE renewal. We blog about news and research related to the field of physical therapy that will keep licensed professionals informed.