New and Revised CPT Codes For 2018
The following are additions and deletions to speech-language pathology related Current Procedural Terminology (CPT) codes and modifiers, effective January 1, 2018.
New CPT Codes
The following new CPT code will replace current CPT code 97532 (cognitive skills development, each 15 minutes).
97127 Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g.,
managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact
(Report 97127 only once per day)
(Do not report 97127 in conjunction with 0364T, 0365T, 0368T, 0369T)
- This code is untimed and can only be billed once per day regardless of the length of the session.
- The 2018 National Correct Coding Initiative Policy Manual for Medicare Services reiterates that, like 97532, 97127 may not be reported on the same day, for the same patient, and by the same provider, as CPT code 92507 (speech, language, voice, communication treatment).
- Medicare will not accept CPT code 97127 and is replacing it with its own 15-minute G-code, G0515, for cognitive therapy. See New Medicare G-code below for additional information.
- Check with non-Medicare payers regarding implementation of 97127. You should also make sure reimbursement rates are reflective of a session, and not 15-minute units.
- Use ASHA's template letter [DOC] to notify your payers regarding 97127.
email@example.com if you find a payer is incorrectly implementing 97127.
Deleted CPT Codes
97532 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes
Revised CPT Codes
No speech-language pathology codes have been revised for 2018.
New Medicare G-code for Cognitive Treatment
G0515 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes
- Medicare will not accept new CPT code 97127 (Cognitive function intervention). Medicare has created G0515 to report cognitive treatment instead.
- G0515 mirrors former CPT code 97532 and should be reported on the claim form exactly as 97532 would have been, and in 15-minute units.
G0515 will be listed as a Medicare "sometimes therapy" code. SLPs should append the -GN modifier to indicate that G0515 was provided under a speech-language pathology plan of care.
- G0515 will count towards the therapy cap and is subject to the multiple procedure payment reductions (MPPR) policy.
- G0515 has no connection to the functional outcomes reporting system, which also uses G-codes.
- Like 97532, G0515 should not be billed with CPT code 92507 (speech, language, voice, communication treatment). Review
Correct Coding Initiative (CCI) edits for more information on same-day billing of CPT codes.
- Non-Medicare payers (i.e., Medicaid, Medicare Advantage or Part C, and private health insurance) may choose to implement either G0515 or 97127. Check with each non-Medicare payer to verify which code they will implement for cognitive treatment.
firstname.lastname@example.org if you find that a payer is incorrectly implementing a new code for cognitive treatment.
2018 Medicare Fee Schedule for SLPs, published in late-November, for further details.
New CPT Code Modifiers
The following new CPT code modifiers can be used to delineate whether a service is habilitative or rehabilitative in nature.
Modifier 96 (Habilitative services)
When a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. Habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. Habilitative services also help an individual keep, learn, or improve skills and functioning for daily living.
Modifier 97 (Rehabilitative services)
When a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. Rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled.
- Affordable Care Act (ACA) compliant plans may use these new modifiers to track habilitative and rehabilitative benefits.
- These new modifiers will not replace existing modifier SZ (habilitative services).
- Check with your payers regarding implementation of the new modifiers.