New CMP amounts adjusted for inflation and quarterly updates to NCCI PTP edits available

Jan 25, 2019
The Bottom Line

New CMP amounts that have been adjusted for inflation and are effective October 11, 2018 were announced in a final rule published by CMS on January 22, 2019. The adjusted amounts apply to CMPs assessed on or after October 11, 2018. For SNFs, NFs and SNF/NFs, the CMP Analytic Tool instructions and calculations will be updated to reflect these changes. Appendix A of the final rule announcement contains the new rates, which have seen an increase.

A quarterly update to the National Correct Coding Initiative (NCCI) and Procedure-to-Procedure (PTP) edits has also been released. Therapists and billers should be aware of these updates. The CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. Version 25.1 of the NCCI Policy Manual for Medicare Services will be effective April 1, 2019. Chapter 23, Section 20.9 of the Medicare Claims Processing Manual is where we’ll see these changes.

Revisions to the NCCI Policy Manual were made in Chapter I, Section N (Laboratory Panel) and Chapter X, Section C (Organ or Disease Oriented Panels.) Additions/revisions to the manual have been italicized in red font.

Facilities should update their billing and therapy software to ensure they’re compliant by the April 1 effective date. The updated manual can be downloaded from CMS’ NCCI Edits webpage.

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