Advocacy & Practice Updates — Advocacy & Practice
ASRS Advocacy Gains: NCCI Edits Removed for OCT-A and IGC and FA Imaging Codes
As reported last month, ASRS submitted a letter to the National Correct Coding Initiative (NCCI) requesting that it revise its Procedure-to-Procedure (PTP) edits affecting CPT code 92137.
- Edits Removed: CMS agreed to delete NCCI Medicare and Medicaid PTP edits between CPT code 92137 and codes 92235, 92240, and 92242, retroactive to October 1, 2025. These changes are expected to be implemented in the April 1, 2026 edit files.
- Edits Retained: CMS will retain edits between CPT code 92137 and codes 92002, 92004, 92012, and 92014. These edits carry a Correct Coding Modifier Indicator (CCMI) of 1, meaning providers may use an appropriate NCCI-associated modifier to bypass the edit when requirements are met.
What This Means:
- For OCT-A procedures, this is a significant step forward. However, edits involving eye codes remain in place for now.
- Make sure to review the 2025 Medicare NCCI Policy Manual, particularly:
* Chapter 1, Section E: Modifiers and Modifier Indicators on the proper use of modifiers 59, XE, XP, XS, & XU
* Section O: Misuse of Column Two Code with Column One Code
Next Steps:
- CMS suggests checking with your Medicare Administrative Contractor (MAC) for billing guidance.
- For non-Medicare payors, note that CMS does not control how other insurers apply NCCI edits.
ASRS has asked NCCI to meet to emphasize the importance of removing the edits from the eye codes and will keep members informed of our progress.
(Published 11.12.25)