The Centers for Medicare & Medicaid Services is withdrawing National Correct Coding Initiative (NCCI) Procedure-to-Procedure (PTP) edits implemented on July 1, 2023, the agency announced Sept. 14.
The NCCI PTP edits between column 1 codes 80305, 80306, and 80307 for presumptive tests and column 2 codes G0480 to G0483 and G0659 for definitive tests will be withdrawn retroactive to July 1, 2023, in a replacement file for the fourth quarter of 2023. Medicare Administrative Contractors (MACs) will adjust those claims with dates of service between July 1, 2023, and Oct. 1, 2023, to allow payment as appropriate under existing payment and coverage policies. Alternatively, laboratories may also choose to use the MAC appeals process if they prefer to not wait for the automatic adjustment to occur, or they can wait to submit claims until after CMS implements the change.
The NCCI program was developed to promote correct coding of Medicare Part B claims nationwide. The NCCI PTP edits are intended to prevent improper payment when incorrect code combinations are reported.