The Current Procedural Terminology (CPT®AMA, 2004) coding system is composed of five-digit codes that identify assessment and treatment procedures and sessions. The codes are required when billing third-party payers and are subject to various rules. This Q & A focuses on rules related to face-to-face time with the patient and how that time is represented in CPT coding.
Q: Do most CPT codes for speech-language pathology and audiology services designate units of time?
No. Almost all of our codes represent a session without regard to time. In other words, whether one spends 20 minutes or 50 minutes with the patient, the same CPT code applies and would yield a fixed reimbursement amount. It is billed only once per session.
Q: Are there any codes that allow billing based on units of time?
Yes. The following codes allow variable billing based on time:
- 92607-Evaluation for speech-generating device, first hour
- 92608-Each additional 30 minutes
- 96111-Developmental testing, per hour
- 96115-Neurobehavioral status exam, per hour
- 97532-Cognitive skills development, each 15 minutes
There are other physical medicine codes (97000 series) with 15-minute designations (e.g., neuromuscular reeducation) but the Centers for Medicare and Medicaid Services (CMS) has indicated that SLPs can only use 97532.
- 92620-Central auditory function, first 60 minutes
- 92621-Each additional 15 minutes
Q: What is the range of minutes appropriate for billing a 15-minute code?
The Medicare program has published rules related to 15-minute codes and many third party payers selectively adopt Medicare rules. Medicare requires at least an 8-minute session in order to bill a 15-minute code. Accordingly, two 15-minute units would require at least 23 face-to-face minutes with the patient. Medicare publishes the following guide:
- 1 unit: 8 minutes to < 23 minutes
- 2 units: 23 minutes to < 38 minutes
- 3 units: 38 minutes to < 53 minutes
- 4 units: 53 minutes to < 68 minutes
- 5 units: 68 minutes to < 83 minutes
- 6 units: 83 minutes to < 98 minutes
Q: What about the range of minutes for 30-minute and 60-minute codes?
The Medicare program has not issued a national policy addressing these time designations, but at least one Medicare fiscal intermediary has ruled that for CPT 92608, a 30-minute code, at least 16 minutes must accrue with the patient. This is an extrapolation of the published 15-minute rule. ASHA is not aware of rulings issued in regard to the minimum duration for 60-minute codes.
Q:May I include the time I spend preparing a written report or otherwise documenting an assessment or treatment session?
No. The CPT system includes only face-to-face time for its timed codes. The time for documentation that must be completed in the patient's presence can be counted. For example, recording data on a patient's responses to stimuli would have to be completed during therapy.
Q: May I use CPT code modifiers to identify untimed code sessions that are exceptionally long or short?
Yes. Modifiers -52 or -22 can be appended to the CPT code to indicate that the session was unusually short or long, respectively. The payer has the option to adjust the payment amount accordingly.
However, if the -22 modifier is used too often, the payer may conclude that the incidence is not "unusual" and thus deny extra payment.
Q: What about the "evaluation and management codes?
A limited number of payers, not including Medicare, allow SLPs and audiologists to bill for office visits and case management (99000 series) usually reserved for physicians. The descriptors for the 99000 codes indicate the nature of the visit and usually a range of time. Some of these codes allow the family or other caregivers to participate directly and do not require the patient's presence.