NCCI Replacement Files 4th Quarter 2023 – Presumptive and Definitive Testing Codes

CMS Implemented the replacement files for the NCCI Procedure to Procedure (PTP) edits for the October 1, 2023 files (PRA and OPH) withdrawing the edits that were effective July 1, 2023. CMS deleted the edits with a replacement file for the 4th quarter of 2023, 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). Any claim that was affected by the procedure-to-procedure edits, including those that did not apply an NCCI modifier, will be processed and paid as appropriate under existing payment and coverage policies.

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.

Source: https://www.cms.gov/medicare/coding-billing/ncci-medicare