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National Correct Coding Initiative (CCI) and Outpatient Code Editor (OCE) Edit Tables

Speech-Language Pathology Services

The National Correct Coding Initiative (NCCI, or more commonly, CCI) is an automated edit system to control specific Current Procedural Terminology (CPT®) code pairs that can be reported on the same day. The Centers for Medicare and Medicaid Services (CMS) developed the edits for use on all Medicare Part B (outpatient) claims. They include CCI edits for provider-based services provided in clinics, private practices, and physician offices, and OCE edits for outpatient hospital-based services. State Medicaid agencies are also required to use CCI edits, but may modify them to meet their own programmatic needs. Other third-party payers may also adopt CCI edits. Please check with non-Medicare payers regarding their use of CCI edits.

Speech-language pathologists (SLPs) should also be aware of Medically Unlikely Edit (MUE) restrictions, which are a subset of CCI edits that limit the number of times individual CPT codes may be billed on the same day, for the same patient.

The new CCI edit preventing same-day billing of CPT codes 92611 and 74230 has been deleted, retroactive to January 1, 2020. For more information, see Medicare Deletes Incorrect Edit, Allows Same-Day Billing of Videofluoroscopic Study of Swallowing by SLPs and Radiologists Without a Modifier.

How to Read the CCI and OCE Edit Table

  • ASHA derived the following speech-language pathology-related CCI and OCE edits from the complete lists of edits published on the CMS website.
  • The tables only list CPT code pairs related to speech-language pathology services that are subject to CCI edit restrictions, including code pairs that
    • cannot be billed together by the same provider for the same patient on the same date of service, or
    • require a modifier to bypass the edit to allow billing for the same patient on the same date of service.
      • Modifier -59 [PDF] indicates "distinct procedural service" and is the only modifier used with CCI edits for speech-language pathology-related codes.
        • Subcategory modifiers may be required by some payers, but are not common: XE (separate encounter), XS (separate organ/structure), XP (separate practitioner), XU (unusual, non-overlapping service).
        • On the claim, list the code in Column 1 first, followed by the code in Column 2. Attach modifier -59 (or appropriate subcategory modifier) to the CPT code listed in Column 2, when applicable.
    • Speech-language pathology-related code pairs are not listed here if they are not subject to CCI restrictions and can be billed on the same day without a modifier.

Note: This is not a comprehensive list. However, every effort has been made to include code pairs typically billed by SLPs. For a full list of edits, see the official CMS resources for Medicare Part B and Medicaid services. Additionally, not all procedure codes included in this list are covered by Medicare when provided by an SLP (for example, radiology services). ASHA includes some CCI edits for informational purposes, as other payers may follow them. For more information on covered Medicare services, see ASHA's CPT coding rules for SLPs.

Table 1: CCI Edits and OCE Edits [1] for Speech-Language Pathology Services

Column 1
CPT Procedure (one)
Column 2
Paired With (one)
Can be performed on same date? Yes/No If so, use what modifier? [2]
Office setting Hospital outpatient setting [1]
31579 [3]    31575 [4] , 92511   N N N/A
31579 70371 [5], 92520 Y Y -59
70370 74230 Y Y -59
70371 74230 N N N/A
74230  74210, 74220 N N N/A
92507, 92508 [6] 97129 and 97130, 97533 N (when both are provided by SLP) N (when both are provided by SLP) N/A
92507 97150  -59 
92507 97153, 97154, 97155, 97156, 97157, 97158  N N N/A 
92508 92507, 97150 Y Y -59
92508 97154, 97155, 97156, 97157, 97158 N/A  N/A 
92520 70371 Y Y -59
92521 96105, 96125 Y Y -59
92521 92620, 92621 N N N/A
92521 97151, 97152  -59 
92522 96105, 96125 Y Y -59
92522 92620, 92621 N N N/A
92522  97151, 97152  -59 
92523 92522, 92620, 92621 N N N/A
92523 96105, 96125 Y Y -59
92523  97151, 97152  -59 
92524 96105, 96125 Y Y -59
92524 92620, 92621 N N N/A
92524  97151, 97152  -59 
92526 92511, 92520, 97129 and 97130, 97150 Y Y -59
92526  G0283, 97032 N N N/A
92597 97755 N N N/A
92607 92507, 92508, 92521, 92522, 92523, 92524, 92609 Y Y -59
92607 92597, 97755 N/A N N/A
92608 97755 N N N/A
92609 92507, 92508, 92521, 92522, 92523, 92524 Y Y -59
92609 97755 N N N/A
92610 92511 Y Y -59
92611 70370, 92511, 92610 Y Y -59
92611 70371, 76120, 76125 N N N/A
92612, 92613, 92614, 92615, 92616, 92617 92610, 92611 Y Y -59
92612 76120, 76125, 31575, 92511, 92520, 92614 N N N/A
92613 76120, 76125, 92520 N N N/A
92614 76120, 76125, 31575, 92511, 92520 N N N/A
92615 76120, 76125, 92520, 92613 N N N/A
92616 31575, 76120, 76125, 92511, 92520, 92612, 92614 N N N/A
92617 76120, 76125, 92520, 92613, 92615 N N N/A
96105 96110, 96125  Y Y -59
96105  97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158  N/A  N/A 
96110 96125 Y Y -59
96110, 96113, 96125  97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158  N/A  N/A 
96112, 96113  96105, 96125  Y -59 
96112, 96113  96110  N/A  N/A 
96112  97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158   -59 
97129, 97130  97153  -59
97129, 97130 97155  N/A 
97150  97533, 97535  -59
97151, 97152  96105, 96110, 96113, 96125  N/A -59 
97153  92507, 96105, 96110, 96113, 96125 N/A  -59 
97153  92508 N -59 
97154  92507,  92508, 96105, 96110, 96113, 96125 N/A -59 
97155, 97156, 97157 92507, 92508, 96105, 96110, 96113, 96125, 97129, 97533 N/A  -59 
97158  92507 Y -59
97158  92508, 96105, 96110, 96113, 96125, 97533 N/A -59 

See Also

[1] Hospital outpatient coding edits are determined by the Outpatient Code Editor (OCE) system which usually includes the same therapy edits as CCI edits. New OCE edits are implemented in hospitals one quarter after initiated as CCI edits. CMS Transmittal 254 (7-30-04) confirms that OCE edits are limited to hospital outpatients. With reference to Transmittal 254, denials should be appealed if based on OCE edits extended to skilled nursing facility, comprehensive outpatient rehabilitation facility, and rehabilitation agency settings.

[2] The -59 modifier denotes that the procedure is distinct or independent from other services performed on the same day. The modifier is attached to the column 2 CPT code, when applicable.

[3] This procedure may require physician supervision based on MAC local coverage determinations (LCDs) or state practice acts. National Medicare policy does not require physician supervision.

[4] This procedure is for medical diagnosis by a physician and is included in this list for information purposes and not for billing by speech-language pathologists.

[5] The 7000 series are radiology codes. These codes are included here for information purposes and not for billing by speech-language pathologists.

[6] A single practitioner, such as an SLP, should not bill CPT codes 92507 or 92508 on the same date of service as 97129/97130 or 97533. However, if the two types of services are performed by different types of practitioners in the same facility and on the same date of service (e.g., an SLP bill 92507 and an OT bill 97129/97130), then the codes may be billed together using the -59 modifier. This policy also applies to other physical medicine codes when billed with 92507, 92508, or 92526. ( National Correct Coding Initiative Policy Manual for Medicare Services, Chapter 11, Section H-3)

For more information on the use of physical medicine codes see the Medicare Coding Rules for SLPs. For more on billing for cognitive therapy, see Coding and Payment for Cognitive Evaluation and Treatment Services.

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