Coding for Reimbursement Frequently Asked Questions: Speech-Language Pathology
- Where can speech-language pathologists obtain a complete listing of codes, both procedure and diagnostic?
- What is a "superbill"?
- What is a CMS 1500 form?
- What are the procedure codes for FEES/FEEST used by speech-language pathologists in any setting?
- What are the procedure codes for voice prosthetics (e.g., artificial larynges, tracheoesophageal prosthetics)?
- What codes describe a clinical swallowing evaluation and modified barium swallow study (MBS)?
- What is the ICD-9 diagnostic code for pediatric verbal apraxia?
- What code do I use for autism? Asperger's Syndrome?
- What code/s should I use for auditory processing (AP) evaluation and treatment?
- Can a speech-language pathologist use 97000 codes (physical medicine), and should they be billed in place of, or with, speech-language treatment codes?
- What is the difference between a speech-generating device and non-speech generating device?
- Can the services provided by a Clinical Fellow (CF) be submitted to a health plan for reimbursement?
- If a speech-language pathologist wants to hire a speech-language pathology assistant can they get reimbursed and what are the regulations?
- A claim reviewer asks, "How much time does it take a speech-language pathologist to do an evaluation that is captured under CPT code 92506"?
- How should speech-language pathologists document their treatment?
- How do I establish fees for speech-language pathology services?
- What are place of service codes and where can speech-language pathologists obtain a complete listing of them, with descriptions?
- Is it appropriate for a speech-language pathologist to report code 92609, Therapeutic services for the use of speech-generating device, including programming and modification, for the programming and modification of the speech-generating device (SGD) if the patient is not present?
- CPT 96125 is "standardized cognitive performance testing." How do I determine that the tests I select are acceptable (i.e., standardized)?
Where can speech-language pathologists obtain a complete listing of codes, both procedure and diagnostic?
ASHA's "Health Plan Coding and Claims Guide" provides resources on coding, billing, appeals, denials, and other helpful information. This guide is available through the ASHA online store or by contacting ASHA's Product Sales at 1-888-498-6699. Ask for Item #0112486.
A list of CPT codes with short descriptors and associated fees for speech-language pathology and audiology can be found in the Medicare Fee Schedule or the Model Superbill for Speech-Language Pathology Practice [PDF]. Go to the American Medical Association's (AMA) Web site to order the official CPT Manual.
What is a "superbill?"
A superbill is a time efficient form to document services, fees, codes, and other information required by health plans. Models are available for download by clicking Superbill for Speech-Language Pathology Practice [PDF].
What is a CMS 1500 form?
Non-institutional providers and suppliers use the CMS 1500 form to bill Medicare Part B services, Medicaid, and private health plans. To print black and white copies [PDF], contact the Centers for Medicare and Medicaid Services (CMS) through their Web site or your local Medicare contractor.
What are the procedure codes for FEES/FEEST used by speech-language pathologists in any setting?
The CPT code for the fiberoptic endoscopic evaluation of swallowing (FEES) is 92612; code 92616 when you include sensory testing (FEEST).
What are the procedure codes for voice prosthetics (e.g., artificial larynges, tracheoesophageal prosthetics)?
The evaluation for voice prosthetics is CPT 92597. Services for training and modification in the use of a voice prosthetic are coded 92507.
What codes describe a clinical swallowing evaluation and modified barium swallow study (MBS)?
The procedure code for a clinical swallowing evaluation is CPT 92610. CPT 92611 is the procedure represents the speech-language pathologist's participation in the MBS or videofluoroscopy. A separate radiology procedure code, CPT 74230 covers the services of the radiologist and the radiology technician.
What is the ICD-9 diagnostic code for pediatric verbal apraxia?
The diagnostic code for "apraxia, acalculia, agnosia, agraphia" is 784.69. Generally, codes in the 700 series are used for organic disorders. You should have neurological information supporting use of this code/diagnosis and should be able to answer the following questions:
- Is there a statement from a neurologist or pediatrician supporting a neurological component?
- How is this child's verbal apraxia different from an articulation disorder?
What code do I use for autism? Asperger's Syndrome?
SLPs are part of evaluation teams for children referred for possible autism spectrum disorder, which includes Asperger’s Syndrome. The SLP diagnoses and treats the speech-language disorder(s) resulting from this medical condition, and serves as a team member that assigns the diagnosis of autism spectrum disorder (ASD). The SLP who has been trained in the reliable and valid use of diagnostic and assessment tools as well as in the clinical criteria for ASD may be qualified to diagnose these disorders as an independent professional.
After the team has evaluated the child and assigned a diagnosis of autism, team members, such as physicians, psychiatrists, occupational therapists, psychologists, and SLPs typically use the ICD-9 diagnostic code 299.0 to report infantile/childhood autism, either as the primary or secondary diagnosis. For example, the SLP treats speech-language disorders so the SLP assigns a speech-language disorder diagnosis as the primary diagnostic code and a code from the 299 category as the secondary diagnosis. The diagnostic code 299.8, under the same psychosis section, is "other pervasive developmental disorders: Asperger's disorder" and is used for Asperger's Syndrome.
The following fifth-digit subclassification is for use with category 299:
- 0 (current or active state)
- 1 (residual state)
Thus, the code for Apserger's would be 299.80, but keep in mind, that would most likely be assigned as the secondary diagnosis by an SLP, with the SLP assigning a speech-language disorder code as the primary diagnosis.
What code/s should I use for auditory processing (AP) evaluation and treatment?
- An SLP performing an AP evaluation should use code CPT 92506. Typically, payers will not allow a second reporting of the same code, so an audiologist performing an AP or central AP evaluation on the same child would use a different set of CPT codes.
- The diagnostic codes used by audiologists for diagnosing central auditory processing disorders are the 388.4 range (other abnormal auditory perception), or 389.14 (central hearing loss), or 794.15 (abnormal auditory function study - if electrophysiological tests are performed).
- The diagnostic codes that may be used by SLPs is 315.32 (developmental mixed receptive-expressive language disorder, central auditory processing disorder).
Can a speech-language pathologist use 97000 codes (physical medicine), and should they be billed in place of, or with, speech-language treatment codes?
Medicare specifically allows speech-language pathologists to use 97532 (development of cognitive skills to improve attention and memory) for treatment of cognitive/communicative disorders, but notes that either code 92507 or 97532 could be used, but not both for the same treatment. Still, many Medicare contractors and private payers may question a speech-language pathologist's use of other Physical Medicine codes from the 97000 series. Clinicians must use the "best" code to describe services, and may need to decide if that code is in the 92000 or 97000 series. CPT code 92507 (treatment of speech-language services) is very comprehensive and generally includes all components of treatment. Using a 92000 code in combination with a 97000 code may constitute unbundling of codes, and is not allowed. Unbundling is when you code one component of a treatment separately when that component is already captured under a more comprehensive code that you are also using.
What is the difference between a speech-generating device and non-speech generating device?
Speech-generating devices produce digital or synthesized speech. HCPCS for speech-language pathology provides a list of E codes for each type of speech-generating device.
Non-speech generating devices are low-tech mechanical or electronic devices that assist with communication.
Contact your carrier or payer if you need additional assistance in determining the type of device.
Can the services provided by a Clinical Fellow (CF) be submitted to a health plan for reimbursement?
There is no uniform standard for private payers, so we look to Medicare's guidance.
Federal Medicaid regulations define CFs as qualified speech-language pathologists and do not mention licensure. However, a state Medicaid program can supercede Federal regulations when the state requirement is more stringent. Thus, Medicaid programs could require licensed practitioners and disallow non-licensed CFs.
If a speech-language pathologist wants to hire a speech-language pathology assistant can they get reimbursed and what are the regulations?
For private health plans, check with the payer in question to determine their provider qualifications. Often, private health plans develop policies that are consistent with those of Medicare.
Under Medicare, services provided by speech-language pathology assistants are not considered medically necessary and therefore are not reimbursable.
A claim reviewer asks, "How much time does it take a speech-language pathologist to do an evaluation that is captured under CPT code 92506?"
This is a good question because 92506 is an untimed code, and speech-language evaluations can be short or extended. So, what is the typical time? CPT codes are used as the basis for payment according to the Medicare resource-based relative value scale, and each code has a practice expense value determined. Part of the process of finding a practice expense value for a procedure includes convening a consensus panel to determine components such as time, equipment, and supplies that are involved in performing that procedure for a "typical" patient. A panel of ASHA members reviewed 92506, and then the agreed upon time was presented to a panel of health care professionals. According to the CMS 2004 Practice Expense Inputs database, a typical time of 156 minutes, including pre-service (e.g., reviewing pertinent records) and post-service time (e.g., writing the report, making phone calls), was determined. Thus, clinicians should keep in mind that a little over 2½ hours is typical for a speech-language evaluation, at least for reimbursement purposes for practice expense values.
How should speech-language pathologists document their treatment?
Different facilities or agencies have different requirements for how services are to be documented (e.g., SOAP notes, narrative) and where notes are to be maintained (e.g., carbonless copies, writing notes directly in the patient's chart, electronic medical record).
Clinicians must consider the needs of the audience for which the documentation is intended. Oftentimes, a variety of related professionals and claims reviewers will read the assessment report, treatment plans, and discharge summaries, so the clinician needs to ensure that what they write can be understood by an audience of varying backgrounds and experience.
Payers may have documentation requirements of their own, including the information they want to see when reviewing a claim and the timelines in which documentation must be submitted. Typically, health plans are instructed by law to initially request only the minimum information necessary to pay a claim.
The following documents provide excellent guidance on documentation requirements:
How do I establish fees for speech-language pathology services?
You may refer to the Medicare Fee Schedule for a general idea of what Medicare reimburses for specific procedures. It is important for you to know that Medicare rates reflect a budgetary constraint and may not reflect current market rates. You can also purchase historic fee data from medical coding publishers. ASHA's "Negotiating Health Care Contracts and Calculating Fees" (available through the ASHA online store; Item #0112450) also offers national charge data to help you evaluate your fees by comparing your charges to those of other practitioners nationwide.
Discussing fees with other local practices may be construed as price-fixing. Setting prices in collusion with colleagues is illegal.
What are place of service codes and where can I obtain a complete listing of them, with descriptions?
Place of service codes are used on claims to specify the entity where service(s) were rendered. Check with individual payers (e.g., Medicare, Medicaid, private health plans) for policies regarding these codes.
You may find a comprehensive list of place of service codes, with descriptions, at the Centers for Medicare and Medicaid Services' (CMS) Web site.
Is it appropriate for a speech-language pathologist to report code 92609, Therapeutic services for the use of speech-generating device, including programming and modification, for the programming and modification of the speech-generating device (SGD) if the patient is not present?
No. Code 92609 is used to report therapeutic services provided by the clinician for use of speech-generating devices. Programming and modifications necessary for the device are included as part of the procedure and are, therefore, not separately reported.
CPT 96125 is "standardized cognitive performance testing." How do I determine that the tests I select are acceptable (i.e., standardized)?
A standardized test is administered and scored in a consistent manner. These tests may be norm-referenced (results are intrepreted based on established norms and compare test-takers to eachother) or criterion-referenced (results are interpreted based on the person's performance/ability to complete tasks or demonstrate knowledge of a specific topic).
McCauley and Strand wrote, "Minimally, measures can be considered standardized tests when they specify standard procedures for administration and interpretation (American Educational Research Association (McCauley, R.J. & Strand, E.A.  A review of standardized tests of nonverbal oral and speech motor performance in children. American Journal of Speech-Language Pathology, 17, 81-91.)