December 20, 2011 News

New Codes Available for AAC Evaluation, Developmental Delay Testing, Preventive Services

Codes for speech-language evaluation and treatment related to alternative and augmentative communication (AAC), developmental delays, and preventive services have been revised or added to Current Procedural Terminology (CPT, © American Medical Association), effective Jan. 1, 2012.

AAC

The CPT includes a new code for AAC devices and revises a second AAC code. CPT 92605, originally the sole procedure code for evaluation for a non-speech-generating AAC device, was revised to include a time factor, "face-to-face with patient; first hour." A new code, 92618 (each additional 30 minutes), is listed separately in addition to the primary procedure 92605. The codes are listed in sequence in the CPT Codebook although they are not in numerical order.

  • 92605 (revised): Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour.
  • 92618 (new): Each additional 30 minutes (list separately in addition to code for primary procedure).

Reimbursement levels for procedures are determined, in part, by the amount of "professional work" assigned to each code. Despite recommendations—which included input from ASHA—from the American Medical Association committee responsible for assigning work values, the Centers for Medicare and Medicaid Services (CMS) assigned a work value of 0.00 to CPT 92605 and CPT 92618 in the 2012 Medicare Physician Fee Schedule (MPFS). CMS justified its decision by claiming that the codes are "always bundled into payment for other services not specified."

Developmental Delay

Two codes related to assessment of development have been revised.

  • 96110 (revised): Developmental screening, with interpretation and report, per standardized instrument form.
  • 96111 (revised): Developmental testing (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments) with interpretation and report.

The official descriptor of CPT 96110 has been revised as a screen rather than "Developmental testing; limited." Testing examples in the descriptor have always been screens; however, based on the revision, Medicare is no longer covering the service, as is its policy for other screens (see main article).

Modifier

A new CPT modifier, 33, is used for a preventive service: "When the primary purpose of the service is the delivery of an evidence-based service in accordance with a U.S. Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by appending modifier 33, Preventive Service, to the service. For separately reported services specifically identified as preventive, the modifier should not be used."

  • 33: New Modifier; Preventive Service; for service in accordance with a U.S. Preventive Services Task Force A or B rating, or other preventive services identified in mandates.

In the descriptor for "Preventive Service," other preventive services identified in preventive services mandates may refer to the Affordable Care Act, which provides specifically for the preventive health needs of children, including developmental screenings and hearing screenings, and may include "screening for autism," noted in a Kaiser Family Foundation publication report [PDF].

The preventive services modifier 33 may be used for the revised code 96110, which was revised from "Developmental testing; limited (e.g., Developmental Screening Test II, Early Language Milestone Screen), with interpretation and report" to "Developmental screening, with interpretation and report, per standardized instrument form."

Janet McCarty, MEd, CCC-SLP, private health plans advisor, can be reached at jmccarty@asha.org.

Steven White, PhD, CCC-A, director of health care economics and advocacy, can be reached at swhite@asha.org.

cite as: McCarty, J.  & White, S. (2011, December 20). New Codes Available for AAC Evaluation, Developmental Delay Testing, Preventive Services. The ASHA Leader.

  

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