June 1, 2013 Departments

Bottom Line: Two Clinicians—But How Many Bills?

In collaborative care, clinicians from two different disciplines may treat a patient at the same time. How do you bill this co-treatment?

As a speech-language pathologist helping an older patient regain swallowing function following a stroke, you might call on an occupational therapist to help with the patient's posture and hand-to-mouth movements. Together, you and the OT work with the patient, perhaps adjusting strategies to ensure safe eating and drinking. Or perhaps an audiologist doing follow-up programming for a child with a cochlear implant asks you to perform speech production treatment while the audiologist assesses and refines the programming.

130601_Bottom_Line.jpgThese scenarios are examples of what Medicare classifies as co-treatment: simultaneous treatment provided during the same session by clinicians from different disciplines. It differs significantly from concurrent treatment (one clinician using different activities to provide services to two patients with different treatment goals at the same time) and group treatment (one clinician using the same activity to provide treatment to up to four patients who have the same goals).

So how does billing work when an audiologist or SLP provides co-treatment with another discipline? The answer depends on whether the third-party payer is private insurance, Medicaid or Medicare, because they have different rules about whether and how co-treatment can be billed. Medicare, however, does not reimburse audiologists for treatment services.

Do all payers allow for co-treatment?

Coverage of co-treatment depends on the payer. Medicare has different rules for Part A patients in skilled nursing facilities and for Part B services (outpatient services provided in clinics, private practices, hospital outpatient facilities and, in some cases, skilled nursing facilities).

  • For Part A services, each clinician may report his or her total face-to-face treatment minutes. All policies regarding mode, modalities and student supervision must be followed.
  • For Part B services, total billing time is limited to the length of the session; one discipline may bill for the entire service or the disciplines may divide the service units. Because SLPs usually bill treatment codes that represent a session (rather than an amount of time), and because Medicare has no published minimum/maximum session length, the SLP would bill for one untimed session.
  • Other payers do not address co-treatment in their policies. In those cases, it is best to check with the payer.

Does Medicaid also cover co-treatment?

Co-treatment coverage depends on the state and the benefits offered by that state's program. Several Medicaid programs include audiologic rehabilitation that may be performed by audiologists and speech-language pathologists together for cochlear implant recipients. The codes typically used for audiologic rehabilitation are session-based, so it is important to check with the individual state Medicaid program about correct codes and billing. If co-treatment is covered, billing procedures will most likely follow those for Medicare Part B.

How many disciplines can participate in co-treatment at the same time?

For Medicare beneficiaries, co-treatment is limited to two disciplines at the same time. SLPs treating Medicare patient could co-treat with occupational or physical therapists.

How do you "share" time if the speech-language code is untimed and the occupational or physical therapy code is timed?

Again, the method of billing depends on the payer. A Medicare Part B session, for example, could be billed as a speech-language pathology treatment session along with the timed treatment codes for the occupational or physical therapy. 

Can you provide examples of when co-treatment might be used?

Three scenarios in which audiologists or SLPs would provide co-treatment might be:

  • Meals/feeding. Speech-language treatment includes teaching safe swallow strategies, bolus manipulation, and naming and requesting food items. Occupational therapy includes fine motor control, grasp-release of utensils and arm movements.
  • Postural control. Speech-language treatment might include respiratory support for speech, phonation, articulation and swallowing function; an OT or PT might work on trunk/core strengthening, sitting balance and postural adjustment.
  • Aural rehabilitation. Audiology treatment may include speech perception with new hearing aids as an SLP works on vocal quality and rate of speech.

When would co-treatment be inappropriate?

Co-treatment is not appropriate if it is used for the providers' scheduling convenience and not for the patient's benefit. If one provider is treating and the other is watching—without making any contribution to the session—only the primary provider would bill for treatment.

What special documentation is needed for co-treatment?

The documentation should clearly indicate the rationale for co-treatment and specify the goals of each discipline addressed in the session. For the shared time, each provider states the goals addressed and progress made. Each provider might also work with the patient individually to address other goals.

Laurie Alban Havens, MA, CCC-SLP, is ASHA director of private health plans and Medicaid advocacy. lalbanhavens@asha.org

cite as: Havens, L. A. (2013, June 01). Bottom Line: Two Clinicians—But How Many Bills?. The ASHA Leader.

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