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by Carolyn Wiles Higdon
Five new Current Procedural Terminology (CPT*) codes for billing services related to speech-generating devices (SGDs) became effective Jan. 1, 2003. The following questions and answers explore reimbursement issues related to Medicare, Medicaid, and private payers.
What are the new AAC codes?
A. The new codes and the descriptors are (if the new code replaces a G code, the replacement is so noted):
- 92605 —Evaluation for prescription of non-speech-generating augmentative and alternative communication (AAC) device
- 92606 —Therapeutic service(s) for the use of non-SGD, including programming and modification
- 92607 —Evaluation for prescription for speech-generating AAC device, face-to-face with the patient; evaluation, first hour (replaces G0197 and G0199)
- 92608 —Each additional 30 minutes (list separately in addition to code for primary procedure; use 92608 in conjunction with 92607)
- 92609 —Therapeutic services for the use of SGD, including programming and modification (replaces G0198)
Will Medicare pay when you use the non-SGD codes?
A. No. These services are not reimbursable under the Medicare program when using the new codes, but can still be used by private payers. Medicare requires that 92506 (evaluation of speech, language, voice, communication…) and 92507 (treatment of speech, language, voice, communication…) be used for non-SGD procedures.
Do these codes apply to voice prosthetics?
A. No, they do not. Evaluations for use and/or fitting of voice prosthetic device(s) to supplement oral speech should be billed under 92597 (supercedes the "old" G0200 temporary code). Modification/training in the use of voice prosthetics should be billed under 92507 until a more accurate code is identified. Private health plans should accept 92507 because CPT 92598 was deleted from the CPT system for 2003.
Will Medicaid be using these codes and pay for them?
A. Yes. Regulations that implement the Health Insurance Portability and Accountability Act of 1996 recognize only the CPT and HCPCS Level II code sets as of October 2002. Medicaid coverage for services over age 20 is optional for AAC services and will vary with each state. Many state Medicaid programs and private health plans, including HMOs and PPOs, have adopted the Medicare Physician Fee Schedule (MPFS) while designating their own conversion factor. ASHA members may wish to negotiate with non-Medicare payers and make clear that the AAC code values were not derived from relative value studies that are the basis for most other MPFS values. For this reason, speech-language pathologists may request that payers negotiate their rates using such resources as the ASHA publication, Negotiating Health Care Contracts and Calculating Fees: A Guide for Speech-Language Pathologists and Audiologists, rather than adopt the MPFS rankings.
Is there anything else that SLPs who provide AAC services should know about coding?
A. At present, there are HCPCS codes that designate the AAC devices themselves. Effective July 1, there will be three new "temporary 'K' codes" for SGDs. At the present time, there is a K code (K0541) for SGD, digitized speech, using pre-recorded messages, less than or equal to eight minutes recording time and K0542 for SGD, digitized speech, using pre-recorded messages, greater than eight minutes recording time. The three new codes are more specific than K0542 for the pre-recorded time. K0542 will be discontinued as of July 1 to be replaced by K0615, K0616, and K0617. The new K codes are:
- K0615—SGD, digitized speech, pre-recorded messages greater than eight minutes but less than or equal to 20 minutes recording time
- K0616—SGD, digitized speech, pre-recorded messages greater than 20 minutes but less than or equal to 40 minutes recording time
- K0617—SGD, digitized speech, pre-recorded messages, greater than 40 minutes recording time
Where can I get more information about Medicare and AAC?
A. Here are several useful Web sites that will provide SLPs with a variety of information about Medicare and AAC:
• ASHA's Professional Site
• Medicare Fee Schedule Information
• AAC-RERC
• Centers for Medicare & Medicaid Services
• PTManager
For more information, contact Mark Kander by e-mail at mkander@asha.org or through the Action Center at 800-498-2071, ext. 4139.
*CPT codes, ©American Medical Association, 2002
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Carolyn Wiles Higdon is interim chair of the department of communicative disorders at the University of Mississippi. She served as a consultant to the ASHA Health Care Economics Committee during the development of the CPT proposals for AAC devices. Contact her by e-mail at carolynwhigdon@aol.com.
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