NCCI Implements Some of SNMMI's Proposed Changes to PTP Edits

March 4, 2021

On March 1, 2021, CMS' National Correct Coding Initiative (NCCI) implemented several Procedure to Procedure (PTP) edit corrections requested by SNMMI for several of the new and revised CPT codes. These edit corrections are retroactive for claims with a date of service (DOS) to January 1, 2020. 

78472/A9512, 78802/A9547, 78804/A9521, 78802/A9521: CMS implemented a PTP modifier indicator of “0” for the code pairs listed below. We urged CMS to consider a modifier indicator of “1” which will allow an NCCI-approved modifier to bypass the edit under appropriate clinical circumstances. CMS implemented the change to modifier "1."

78800/A9569, 78802/A9530, 78802/A9531, 78802/78830; 78802/78832: CMS implemented a PTP modifier indicator of “0” for the code pairs. We recommended the removal of any edits for these code pairs as these are common NM services and tracers. CMS implemented the removal of these edits. 

78802/A9570, 78804/A9569, 78804/A9570: CMS implemented a PTP modifier indicator of “0” for the code pairs. We recommended the removal of any edits for these code pairs (and several others) as these are common NM services and tracers. CMS agreed to remove the edits for these code pairs. However, CMS has not implemented these changes yet.

The official update files are available for viewing at www.cms.gov.

For general questions on this manner, please contact hpra@snmmi.org. If you would like to report an issue with a code, please contact Denise Merlino at merlinohccc@gmail.com and SNMMI staff at hpra@snmmi.org.