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 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?
- 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?
A list of CPT codes with descriptors and associated fees for speech-language pathology can be found in the
Medicare Fee Schedule or the
Model Superbill for Speech-Language Pathology Practice [DOC]. Go to the
American Medical Association's (AMA) website to order the official CPT Manual. Diagnosis codes relevant to speech-language pathologists are also available on
ASHA's ICD-10 website. Go to the
National Center for Health Statistics website for the official ICD-10-CM list.
ASHA's annual "Coding and Billing for Audiology and Speech-Language Pathology" product provides CPT codes, ICD codes, and fee data in one reference. This guide is
available through the ASHA online store or through ASHA's Product Sales at 1-888-498-6699.
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 selecting
Superbill for Speech-Language Pathology Practice [DOC].
What is a CMS 1500 form?
Non-institutional providers and suppliers with less than 10 full-time employees can use the CMS 1500 form to bill Medicare Part B services in place of electronic billing. Some Medicaid and private health plans may also require you to file claims for reimbursement on the CMS 1500 form, but you should check with each payer. The Centers for Medicare and Medicaid Services (CMS) does not supply the form; providers should purchase claim forms through the
U.S. Government Printing Office, local printing companies in your area, office supply stores, or online. The only acceptable claim forms are those printed in Flint OCR Red, J6983 (or exact match) ink, and copies of the form cannot be used for submission of claims. A
[PDF] is available on the CMS site, but cannot be used for submission of claims.
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 code/s should I use for auditory processing (AP) evaluation and treatment?
An SLP performing an AP evaluation should use code CPT 92523, the code for a speech sound production and language evaluation. AP treatment should be coded under CPT 92507, the code for speech, language, voice, communication, and/or auditory processing disorder treatment.
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.
ASHA's ICD-10-CM FAQs for information on appropriate diagnosis coding for auditory processing disorder for SLPs.
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 on the same day by the same provider. 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
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.
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.
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
list of place of service codes, with descriptions, at the Centers for Medicare and Medicaid Services' (CMS) website. Private practices are often coded as an "office" location.
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 interpreted based on established norms and compare test-takers to each other) 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).
According to the American Medical Association, standardized instruments are "previously
validated tests that are administered and scored in a consistent or 'standard' manner" and "the use of multiple instruments for brief assessments does not replace...testing and is not intended for diagnostic purposes." Reference: "Coding Update: Central Nervous System Assessments/Tests 2015" CPT Assistant, 25(8), 5.