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CMS NCCI edits impact claims for transcranial magnetic stimulation (TMS)

Claims will deny if office visits and add-on codes are billed on the same day as TMS

If you bill for TMS services, you may have experienced your claims denying when you have used modifiers or add-on codes for the same date of service as the TMS service. Until recently, providers were able to bill TMS services with modifier -59, office visits with modifier -25, and an add-on therapy code and get paid for all three services.

Providers can no longer bill office visits and add-on codes on the same day as the TMS service, regardless of modifiers.

To assure proper coding, Magellan applies Centers for Medicare and Medicaid Services’ (CMS) National Correct Coding Initiative (NCCI) claim edits to claim submissions.

Note that we continually assess better solutions in applying consistent reimbursement using industry-standard guidelines. Be sure to review CMS’ NCCI webpage regularly to keep up-to-date on the specific edits that may affect your practice and payment for care to Magellan members.

Thank you for your focus on helping members achieve their goals and work toward better lives! We all know that administrative tasks can be a hassle; however, taking just an extra moment to ensure the accuracy of your claim submissions will help reduce errors and expedite payment.

As always, Magellan remains fully committed to reimbursing you accurately and promptly.

You can find policies relating to claims in the Magellan provider handbook (PDF), Provider Reimbursement section.

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About Provider Focus

Welcome to Provider Focus, our award-winning e-newsletter for network providers! Here you’ll find articles and information to keep you up-to-date on news and topics relevant to serving Magellan members, including a section for regional- and plan-specific news. Check back as a new issue is released each quarter.

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