March 5, 2020
CMS is temporarily deleting procedure-to-procedure (PTP) edits with several radiopharmaceuticals retroactive to January 1, 2020 (Listed below). (Announcement posted February 28, 2020)
SNMMI has confirmation from CMS officials that there are incorrect edits in the National Correct Coding Initiative (NCCI) for several of the new and revised CPT codes that went into effect on January 1, 2020.
After reviewing this issue more closely, CMS has made the decision to delete the following January 1, 2020 Procedure to Procedure (PTP) edits:
The SNMMI continues discussions with CMS officials and the NCCI contractor as well as the American Medical Association for assistance with identified NCCI edit errors. SNMMI is in the process of reviewing and compiling other coding issues to get a complete list to CMS.
At this time it is the society’s recommendation to continue billing as usual. The line item radiopharmaceutical will deny payment; however, it is necessary for providers to continue to bill so when the correction is made, providers will be correctly reimbursed. Providers may choose to appeal the denials and may wish to share this communication with the contractors. The Medicare Administrative Contractor (MAC) will be required to pay on any edit until it is identified as an error; however, once the edit is identified, as those in the table have been identified, you may appeal to your local MAC for payment. The contractor may ask for the claim to be appealed or they may do a mass adjustment—those decisions come after the NCCI contractor confirms and accepts our notice to the errors.
SNMMI will be discussing these edits with the contractors, and we will provide updates as they become available. If you would like to report an issue with a code, please contact Denise Merlino at email@example.com and the SNMMI staff at firstname.lastname@example.org.
These changes will be retroactive to January 1, 2020 and will be implemented in a future edit update. The update will be available at the following websites:
For general questions on this manner, please contact email@example.com.