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The analysis of any legal or medical billing is dependent on numerous specific facts — including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly. CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

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Procedure to Procedure Edits

Members have full access to our therapy PTP edit guides and can request information about a code or pair of codes.

Latest updates are effective July 1, 2023  

Procedure to Procedure Edits Basics

Modifier 59 and X~ Modifiers 

      PTP Edits - Practitioners
        • Physical Therapists
        • Occupational Therapists
        • Speech-Language Pathologists
        • Private Practice

      PTP Edits - Hospitals

      PTP edits are applied to Types of Bills (TOBs) subject to the Outpatient Code Editor (OCE) for OPPS. These edits are applied to:

        • Outpatient hospital services and other facility services;
        • Therapy providers (Part B Skilled Nursing Facilities (SNFs));
        • Comprehensive outpatient rehabilitation facilities (CORFs);
        • Outpatient physical therapy and speech-language pathology providers (OPTs); and
        • Certain claims for home health agencies (HHAs) billing under TOBs 22X, 23X, 75X, 74X, 34X.

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