November 1, 2013 Departments

Policy Analysis: Florida SLPs Can Use Cognitive Treatment Code for Medicare

In response to ASHA advocacy, a Medicare administrative contractor changes its speech-language local coverage determination.

First Coast Service Options, Inc., recently agreed to include the cognitive treatment code for services by speech-language pathologists, a move prompted by ASHA advocacy and intervention.

Beginning last month, the Florida Medicare administrative contractor allows SLPs to bill CPT 97532 (Common Procedural Terminology © American Medical Association), "Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), one-on-one patient contact, each 15 minutes."

Although the Centers for Medicare and Medicaid Services has long recognized coverage of cognitive rehabilitation treatment by SLPs, individual MACs throughout the country determine the CPT codes that providers in their jurisdiction may bill. In April, ASHA submitted a "reconsideration request" to First Coast Service Options, asking that the cognitive treatment code be listed for use by SLPs. First Coast agreed to the request, and last month included it in its local coverage determination for Therapy and Rehabilitation Services after a 45-day notice period.

With this decision, every MAC that has a local coverage determination for speech-language services now includes CPT 97532.

Under the previous First Coast policy, cognitive services provided by SLPs were included in the broad CPT code 92507 (Treatment of speech, language, voice, communication, and/or auditory processing disorder). Allowing SLPs to bill CPT 97532 clarifies that SLPs may, indeed, provide cognitive rehabilitation services. The two codes cannot be billed for a single patient on the same day.

ASHA had also requested that First Coast add CPT 96125, "Standardized cognitive performance testing," to its rehabilitation local coverage determination. First Coast responded by including CPT 96125 in its local coverage determination for psychological and neuropsychological tests, making it difficult for SLPs to access the code. ASHA will continue to advocate with First Coast for a more appropriate placement of this code.

For an explanation of which cognitive services are within the scope of Medicare coverage, see "New Cognitive Code Use Is Inconsistent" (The ASHA Leader, July 3, 2012) and ASHA's reimbursement website.

Mark Kander, is ASHA director of health care regulatory analysis.

cite as: Kander, M. (2013, November 01). Policy Analysis: Florida SLPs Can Use Cognitive Treatment Code for Medicare. The ASHA Leader.


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