Who’s ready for some good news? According to reports from the American Physical Therapy Association (APTA), the Centers for Medicare and Medicaid Services (CMS) has lifted the remaining restrictive NCCI changes the entity implemented this past January.

The Initial Changes

As we reported here, the initial changes meant that PTs and OTs who billed for an initial evaluation in conjunction with CPT® code 97530 (therapeutic activities) and/or 97150 (group therapy)—on the same date of service and for the same patient—would only receive payment for the evaluation. Use of modifier 59 did not allow therapists to bypass nonpayment. This change also impacted athletic training evaluations and re-evaluations.

Additionally, the changes indicated that if a provider billed an evaluation code with CPT® 97140 (manual therapy) on the same date of service, then he or she had to affix modifier 59 to one of the codes in order to receive reimbursement. As a result, the following common code pairings were required modifier 59 to be affixed in order to be reimbursed:

  • 97530 and 97116
  • 97161 and 97140
  • 97162 and 97140
  • 97163 and 97140
  • 99281–99285 and 97161–97168
  • 97110 and 97164
  • 97112 and 97164
  • 97113 and 97164
  • 97116 and 97164
  • 97140 and 97164
  • 97150 and 97110
  • 97150 and 97112
  • 97150 and 97116
  • 97150 and 97164

The Ruling Reversals

As we reported here, CMS reversed some of the most damaging NCCI changes in late January—specifically, changes that only allowed providers to receive reimbursement for evaluations when billed alongside CPT® codes 97530 (therapeutic activities) and/or 97150 (group therapy). But the remaining changes to the aforementioned code pairs held firm.

However, after much advocacy and petitioning, the APTA announced earlier this week that the remaining changes have been reversed and therapists no longer need to affix modifier 59 to the code pairings noted in the previous section. These changes impact all Medicare and Medicaid programs and are retroactive starting on January 1, 2020. For more information on this change, check out this article from the APTA.