American Speech-Language-Hearing Association

National Correct Coding Initiative (CCI) and Outpatient Code Editor (OCE) Edit Tables

Speech-Language Pathology Procedures

The following tables for speech-language pathology related CCI and OCE edits are derived from the complete lists of edits published on the Centers for Medicare & Medicaid Services (CMS) CCI website. They apply to both Medicare Part B and Medicaid services.

The tables list:

  • Code pairs that cannot be billed together for the same patient on the same date of service
  • Code pairs that can be billed together for the same patient on the same date of service by attaching a -59 modifier to bypass the code edit. The modifier indicates that the two procedures are separate and distinct (must be supported in the medical record)
    • Modifier -59 should be attached to the CPT code listed in Column 2, when applicable

Note: SLP-related code pairs that are not listed here are not subject to CCI restrictions and can be billed on the same day without a modifier. However, speech-language pathologists should also be aware of Medically Unlikely Edit (MUE) restrictions.

Table 1: CCI Edits and OCE Edits [1] for Speech-Language Pathology Procedures

 

Column 1

CPT Procedure (one)

Column 2

Paired With (one)

Can be performed on same date? Yes/No

If so, use what modifier?[2]

 

 

Office setting

Hospital outpatient setting [1]

 

31575[3] 31579

N

N

N/A

31579[4] (videostrobe)

70371, 92520

Y

Y

-59

74230[5]

70731, 74210, 74220

N/A

N

N/A

92507, 92508 [6] 97532, 97533 N (when both are provided by SLP) N (when both are provided by SLP) N/A

92508 (SLP group)

92507

Y

Y

-59

92520 (laryngeal function)

70371 (rad. speech eval)

Y

Y

-59

92521 (fluency evaluation) 96105, 96125

Y

Y

-59
92522 (speech sound production evaluation) 96105, 96125

Y

Y

-59
92523 (speech sound production and language evaluation) 92522

N

N

N/A
92523 96105, 96125

Y

Y

-59
92524 (qualitative analysis of voice and resonance) 96105, 96125

Y

Y

-59
92526 97532

Y

Y

-59

92526 (dysphag tx)

92520 (laryngeal function), 92511

Y

Y

-59

92526 (dysphag tx)

(G0283=97014), 97032

N

N

N/A

92607 (SGD eval)

92507, 92508, 92521, 92522, 92523, 92524, 92609

Y

Y

-59

92607

92597 (voice prosth eval), 97755

N/A

N

N/A

92608 97755

N

N

N/A

92609 92507, 92508, 92521, 92522, 92523, 92524

Y

Y

-59

92609 97755

N

N

N/A

92610 92511

Y

Y

-59

92611 (MBS)

92511, 92610

Y

Y

-59

92611

76120, 76125

N

N

N/A

92612 (FEES) 31575, 92511, 92520, 92614 N N N/A
92612 92610, 92611

Y

Y

-59

92613

92520

N

N

N/A

92613, 92615, 92617 (physician report)

92610, 92611

Y

Y

-59

92614 (sensory test)

92610, 92611

Y

Y

-59

92614

31575, 92511, 92520

N

N

N/A

92615

92520, 92613

N

N

N/A

92616 (FEESST)

31575, 92511, 92520, 92612, 92614

N

N

N/A

92616 92610, 92611

Y

Y

-59

92617

92520, 92613, 92615

N

N

N/A

96105 (aphasia assessment)

96110 (dev screen), 96111 (dev testing), 96125 (cognitive testing)

Y

Y

-59

96110 (dev screen), 96111 (dev testing) 96125 (cognitive testing)

Y

Y

-59

 

 

See Also

 


[1] Hospital outpatient coding edits are determined by the Outpatient Code Editor (OCE) system which usually includes the same therapy edits as CCI edits. New OCE edits are implemented in hospitals one quarter after initiated as CCI edits. CMS Transmittal 254 (7-30-04) confirms that OCE edits are limited to hospital outpatients. With reference to Transmittal 254, denials should be appealed if based on OCE edits extended to skilled nursing facility, comprehensive outpatient rehabilitation facility, and rehabilitation agency settings.

[2] The -59 modifier denotes that the procedure is distinct or independent from other services performed on the same day. The modifier is attached to the column 2 CPT code, when applicable.

[3] This procedure is for medical diagnosis by a physician and is included in this list for information purposes and not for billing by speech-language pathologists.

[4] This procedure may require physician supervision based on MAC local coverage determinations (LCDs) or state practice acts. National Medicare policy does not require physician supervision.

[5] The 7000 series are radiology codes. These codes are included here for information purposes and not for billing by speech-language pathologists.

[6] A single practitioner, such as an SLP, should not bill CPT codes 92507 or 92508 on the same date of service as 97532 or 97533. However, if the two types of services are performed by different types of practitioners on the same date of service (e.g., an SLP bills 92507 and a PT bills 97532), then the codes may be billed together using the -59 modifier.

For more information on the use of physical medicine codes see the Medicare Coding Rules for SLPs. (National Correct Coding Initiative Policy Manual for Medicare Services, Version 16.3 [ZIP], Chapter 11, Section H-3)

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