Problem with CCI Edits and New PT/OT Evaluation Codes

February 2, 2017
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We have been made aware that there is an issue with the NCCI edits related to the new therapy evaluation codes. If the code pairs below are billed on the same day, the code edits will generate an error indicating that these codes cannot be charged on the same day. CMS has issued a notice to the MACs on a work around regarding this issue, and the edits will be corrected with the April 1 update. OT Evaluation Codes.

Problematic code pairs

• 97162 and 97165: PT eval – moderate complexity and OT eval low complexity
• 97163 and 97165: PT eval – high complexity and OT eval low complexity
• 97164 and 97165: PT reevaluation and OT eval low complexity