Changes to CMS's National Correct Coding Initiative resulting in some claims reprocessing, starting Apr. 1, 2020

Update: A previous version of this article stated that we would not be reprocessing claims paid via the Ambulatory Payment Classification (APC) model. We've determined that some APC model claims will have a change in payment as a result of the retroactive changes made to CMS's National Correct Coding Initiative (NCCI) policies. Therefore, we'll be reprocessing APC model claims so those that require additional reimbursement will receive it. 

The Centers for Medicare and Medicaid Services (CMS) has made multiple retroactive changes to its National Correct Coding Initiative (NCCI) policies.

Our systems will be updated by Apr. 1, 2020 to reflect these changes. We'll reprocess impacted facility and professional claims with dates of services of Jan. 1, 2020 and after across all product lines, including Medicare, Medicaid and commercial group and individual.

What were the changes?

  • CMS temporarily deleted procedure-to-procedure edits for several radiopharmaceuticals retroactive to Jan. 1, 2020
  • HCPCS radiology codes G2061, G2062 and G2063 replaced G2029, G2030 and G0231, effective Jan. 1, 2020
  • CMS retained edits in effect prior to Jan. 1, 2020 for various code pairs related to physical therapy

See CMS’s NCCI updates for more details.

What should you do?

There are no changes to how you bill, and you should not submit appeals for claims with these codes. We'll reprocess impacted claims according to CMS's changes starting Apr. 1, 2020. This may result in payment of previously denied services.