Please Take Note:
Sep 14, 2023 Replacement Files (4th quarter of 2023) – CMS issued replacement files for NCCI Procedure to Procedure (PTP) edits for the October 1, 2023 files.
Effective July 1, 2023, CMS implemented NCCI PTP edits between Column One codes 80305, 80306, and 80307 for presumptive test(s), and Column Two codes G0480 – G0483, and G0659 for definitive test(s).
CMS will withdraw these edits retroactive to July 1, 2023 in a replacement file for the 4th quarter of 2023.
The MACs will adjust those claims with dates of service between July 1, 2023 and October 1, 2023 to allow payment as appropriate under existing payment and coverage policies. Alternatively, a laboratory may also choose to use the MAC appeals process if it does not wish to wait for the automatic adjustment to occur, or it can wait to submit its claims until CMS implements the change.
This means that billing G0480 – G0483 with 80305 – 80307 will now be allowed with a modifier 59. Any billed since July 1st will be mass adjusted. If you do not want to wait for the adjustment, you can appeal.
Read it here: https://www.cms.gov/medicare/coding-billing/ncci-medicare