December 1, 2013 Departments

Bottom Line: One Code Does Not Fit All

Beginning Jan. 1, four new specific evaluation codes replace the general speech-language evaluation code.

On Jan. 1, four new codes for billing speech-language evaluations take effect: Evaluations for speech fluency, speech sound production with or without language, and voice and resonance now have their own procedure codes, replacing the current code that captures all evaluations.

The four new CPT codes (Current Procedural Terminology, ©American Medical Association) will replace CPT 92506 (Evaluation of speech, language, voice, communication, and/or auditory processing):

  • 92521, Evaluation of speech fluency (e.g., stuttering, cluttering).
  • 92522, Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria).
  • 92523, Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language).
  • 92524, Behavioral and qualitative analysis of voice and resonance.

Why are four codes replacing CPT 92506?

The change stems from the 2009 regulation allowing private-practice speech-language pathologists to bill Medicare directly for their services. In response, the AMA's Relative Value Update Committee re-evaluated speech-language pathology codes to include "professional work" value. "Professional work," one of three components of a code's reimbursement value, reflects the amount of time, technical skill, physical effort, stress and judgment required to provide the service. Prior to 2009, SLPs were considered "technical support" and their work was included in the "practice expense" component of the code's reimbursement formula.

The AMA committee recognized that CPT 92506 reflected more than one procedure, and wanted more specific codes for each type of evaluation. ASHA's Health Care Economics Committee, in collaboration with experts from ASHA's Special Interest Groups, developed the codes and submitted them to the AMA committee.

Unlike practice expense, professional work values do not change over time. The conversion of speech-language procedure codes from practice expense to work values allows the codes, and therefore the reimbursement rates, to remain relatively stable.

How will reimbursement rates compare?

Because CPT 92506 included many different evaluation procedures, SLPs received the same flat rate regardless of how many different disorders they evaluated. The new codes essentially reflect smaller components of the original 92506, so SLPs should expect to see lower payments for each type of evaluation.

What is the reimbursement rate for each code?

The Centers for Medicare and Medicaid Services typically announces new reimbursement rates in November in the Medicare Physician Fee Schedule. Other third-party payers generally publish new payment rates after the release of the MPFS.

The 2014 MPFS was not available at press time. ASHA will post the 2014 national rates for speech-language pathology codes after the MPFS is released.

Are the new codes appropriate for services provided to adults and children?

Yes, SLPs may use these codes for any patient population, provided they are the codes that are most descriptive of the evaluation being provided. Keep in mind that other evaluation codes cover most of the adult population, such as those for dysphagia, aphasia and cognitive performance. See a full list of CPT codes available to SLPs.

Can the new codes be billed together on the same day or with other existing codes?

The CPT Handbook does not restrict an SLP's ability to bill these codes together because there are circumstances in which it is appropriate to evaluate a patient for multiple disorders at the same time. In those cases, documentation should clearly reflect a complete and distinct evaluation for each disorder. SLPs should not bill evaluation codes for brief assessments that could be considered screenings.

Although there are no restrictions in the handbook, there may be restrictions on the new codes in upcoming CMS edits, which are released quarterly. ASHA will closely monitor the edits and inform members of any restrictions on same-day billing that arise. All new or updated edits will be posted on ASHA's website.

Why is 92523 a combined speech sound production and language evaluation? What if I perform only a language evaluation?

If two or more procedures are billed together at least 51 percent of the time, it is standard to develop a bundled CPT code for that set of services. During the code development process, ASHA surveyed many practices and clinics and confirmed that a child evaluated for language is also evaluated for speech sound production ability more than 80 percent of the time. However, the opposite is not true: It is common for a child to be evaluated for speech sound production ability independent of a language evaluation, which is why there is a stand-alone code for speech sound production evaluation.

If a patient is evaluated only for language, SLPs should bill 92523 with the -52 modifier, which is used when services provided were less than the full description of the service.

Where can I find more information about the new codes?

More information is available at our CPT codes page. The site is updated continually with new coding tips and FAQs. Direct specific questions to ASHA's health care economics and advocacy team at reimbursement@asha.org.

Neela Swanson, is ASHA director of health care coding policy. nswanson@asha.org

cite as: Swanson, N. (2013, December 01). Bottom Line: One Code Does Not Fit All. The ASHA Leader.

  

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