All Outpatient Occupational Therapy Services Subject to Correct Coding Edits Effective January 1
On January 1, 2006, the Centers for Medicare and Medicaid Services (CMS) will apply Medicare's National Correct Coding Initiative (NCCI) edits to all outpatient occupational therapy services provided to Medicare beneficiaries, regardless of setting.
The NCCI is an edit system that was developed to promote national correct coding methodologies and eliminate improper coding. Currently, OT claims billed "incident to" the services of a physician, by private practitioners, and hospital outpatient departments are subject to the NCCI edits. After January 1, the following institutional settings providing occupational therapy services also will need to understand how the edits affect payment for therapy services:
- Skilled Nursing Facilities (SNFs) - inpatient part B and outpatient
- Comprehensive Outpatient Rehabilitation Facilities (CORFs)
- Outpatient physical therapy and speech-language pathology providers (OPTs)
- Home Health Agencies (HHAs) - for Part B patients not under a HHA treatment plan of care
Occupational therapy providers should review the relevant CMS MedLearn Matters article for information containing the latest updates and corresponding Internet links.