Medicare Changes to Billing Combinations

More CCI edits have arrived...

CMS is back at it again making the lives of therapists unnecessarily difficult without explanation.

The rehab industry has just learned of multiple changes to Medicare’s CCI edits in relation to Therapeutic Activities, Manual Therapy, and Group Therapy. The following changes are what we currently know:

  • Manual Therapy (97140) is now requiring a 59 modifier when billed with an Evaluation code. We have automatically added the following CCI edits to all On-Site and Web databases.

  • Therapeutic Activities (97530) and Group Therapy (97150) CAN NO LONGER be billed with Evaluation codes for Medicare claims. Medicare WILL NOT be paying on these claims. In order to proactively prevent your clinic from accidentally billing these combinations of codes, we highly recommend that you manually enter these CCI edits into your system to protect against prohibited combinations being billed. We also recommend that you educate your therapists on these changes so that they are aware regardless.

If you have any questions or concerns on this matter, please do not hesitate to contact our support department.

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