On 1/24/2020, CMS released a statement that recent updates to the NCCI edits that impacted the delivery of therapy would be reversed. These edits included therapeutic activity (97530) and group therapy (97150) when billed on the same day as physical (97161, 97162, 97163) or occupational (97165, 97166, 97167) therapy evaluations. Under the edits that were released January 1, 2020, the evaluation codes were not permitted to be billed on the same day as the treatment codes 97530 and 97150. There was significant outcry from not only the therapy industry but many other national healthcare organizations as this edit that was recommended by the contractor, Capitol Bridge, LLC, would have an impact on the care that our patients needed and deserved. We consider this a win in favor of the patients.
At this time, there are more questions that still need to be answered by CMS, including the question everyone is wondering, “When will this be active? And will the retroact it to the beginning of the year?” CMS still needs to communicate to all the Medicare Administrative Contractors (MACs). We plan to continue to update as CMS releases more information about the timeline of all the changes.