Most Commonly Used NCCI Edits for PT, OT, and SLP Private Practice Settings

Some things go better together: peanut butter and jelly, chips and salsa, fish and chips. Likewise, rehab therapists often perform certain procedures that are similar to one another—but they might not know that two or more specific therapy types form “edit pairs.” Subsequently, they’re left in the dark about collecting a bigger portion of Medicare’s payment pie. So how can you, the rehab therapist, determine which therapy services are mutually exclusive? It’s as simple as identifying one primary CPT code and checking to see if another corresponds, or “matches,” with it. If both codes match, you can bill for modifier 59; if the codes don’t match up, then you shouldn’t bill the CPT code in combination with the primary one. Make sense?

We’ve created a comprehensive table with the most commonly used NCCI edit pairs, taking into account the big changes CMS made for 2021. This will make forming edit pairs as simple and enjoyable as milk and cookies. Want it in a printable, easy-to-reference PDF? Enter your email address, and we’ll send it your way!

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