Therapy Edits Reversed!

In response to a massive advocacy campaign, CMS made the decision to delete limiting edits that were put in place 1/1/2020. As a result, therapeutic activities (97530) and group (97150) codes are now able to be used again for treatment on the same dates as PT and OT evaluations allowing clinicians the freedom to initiate patient care delivery without delay.

Please see below an excerpt from Capitol Bridge NCCI Contractor for CMS that was published Friday Jan 24, 2020.

“After reviewing this issue more closely, CMS has made the decision to retain the edits that were in effect prior to January 1, 2020 and to delete the following January1, 2020 PTP edits:”

Column 1: Column 2:

97530 97161

97530 97162

97530 97163

97530 97165

97530 97166

97530 97167

97150 97161

97150 97162

97150 97163

97150 97165

97150 97166

97150 97167

“You may notify your members of these edit changes. CMS will provide further information when it becomes available regarding impacted claims.”

Let's Get to the Point:

PT’s and OT’s are now able to eval and utilize treatment including therapeutic activities and group on the same day as clinically indicated. Advocacy is truly impactful! P
lease let us know if we can be of help!