Due to SNMMI’s diligence, CMS’ National Correct Coding Initiative (NCCI) confirmed that its proposed Procedure to Procedure (PTP) edits for several of the new and revised CPT codes (effective Jan. 1, 2020) will be corrected. On July 6, 2020, SNMMI and the American College of Radiology (ACR) sent a letter with a complete list of PTP edits it compiled from member complaints and other sources.
- 78472/A95120, 78802/A95470, 78804/A95210: CMS proposed 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 approved the change to modifier “1.”
- 78802/A95700, 78804/A95690, 78804/A95700: CMS proposes 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 agreed to remove the edits for these code pairs.
These PTP coding 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: Here for Medicare and here for Medicaid.
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