Wiki NCCI Edit disputes

[smors1]

We are a Behavioral Health provider (ABA) for children with autism and also might provide OT/PT and/or SLP therapy in conjunction with ABA. These therapists are providers billing separate claims under their own NPIs but under our group tax ID#. According to NCCI, we cannot bill codes for the therapies as well as ABA on the same DOS. This only pertains to 2 carriers at the present time: Aetna and UHC. These code pairs show a modifier indicator of -0- indicating they must never be billed together.
I have been unable to find a mechanism at CMS or the NCCI publisher on how to dispute the pairing of these code sets. Has anyone had success in doing so and do you have a contact name, phone # , or website address?

 

[sls314]

We are a Behavioral Health provider (ABA) for children with autism and also might provide OT/PT and/or SLP therapy in conjunction with ABA. These therapists are providers billing separate claims under their own NPIs but under our group tax ID#. According to NCCI, we cannot bill codes for the therapies as well as ABA on the same DOS. This only pertains to 2 carriers at the present time: Aetna and UHC. These code pairs show a modifier indicator of -0- indicating they must never be billed together.
I have been unable to find a mechanism at CMS or the NCCI publisher on how to dispute the pairing of these code sets. Has anyone had success in doing so and do you have a contact name, phone # , or website address?

It's on the CMS website on the NCCI main page. There's a mailing address, email, and fax.

https://www.cms.gov/medicare-medicaid-coordination/national-correct-coding-initiative-ncci/ncci-medicare#contact

The NCCI Contractor is able to address general questions and concerns about the NCCI program and edits. Claim-specific inquiries must be directed to the MAC because NCCI edits are implemented by the MACs as part of routine claim processing. This includes appeals of NCCI-related denials; see Submitting an Appeal below.

You may submit inquiries about the NCCI program, including those related to NCCI (PTP, MUE, and Add-on Code) edits, in writing via email to NCCIPTPMUE@cms.hhs.gov or postal mail to:

National Correct Coding Initiative Contractor
P.O. Box 246
Pittsford, NY 14534

Fax #: 1.585.510.7234

**NOTE** Any submissions made to the NCCI contractor that contain Personally Identifiable Information (PII) or Protected Health Information (PHI) are automatically discarded, regardless of the content, in accordance with federal privacy rules the NCCI Contractor must comply with.

The NCCI program cannot answer questions outside of our scope or about other CMS programs. For example, we cannot answer questions about modifiers not associated with NCCI, Local Coverage Determinations, changes to code descriptors or status indicators.