Converting from Timed to Untimed CPT Codes
Suggested Strategies
ASHA suggests that speech-language pathologists take a proactive
approach using the following strategies when you are advised by
payers that there are no time components associated with most
speech-language pathology and audiology CPT codes.
Billing in Time Units
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Important
Setting prices with input from your competitors
is illegal. Avoid price fixing by refraining from
activities such as discussing charges for
speech-language pathology procedures with your
peers.
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If you choose and can negotiate the continuance of billing in
time units, you should
obtain written verification
from the health plan about the policy allowing this. Please
remember, however, that the Center for Medicare Management (CMM) at
the Centers for Medicare and Medicaid Services (CMS) will not allow
the addition of time units and that the CPT policy does not
designate time units for the codes in question. It is up to you and
the health plan to agree to use time units. You should consider
contacting your
ASHA State Advocate for Reimbursement (STAR) member
. An organized
state speech-language-hearing
association
response to a revision in payment policy can be more fruitful than
that by a single speech-language pathologist.
Appealing Audits
If you are audited and asked to make a refund, realize that
there are resources to assist you in defending past practices of
using timed codes. You can appeal the health plan decision or file
a grievance (check with the health plan's policies) and a
compromise may be reached (as clinician Kathleen Helfrich-Miller
writes about in the June 19, 2007 ASHA Leader, volume 12, number 8,
pages 18-19). Confirm that changes to using untimed codes also need
to be made and
negotiate for the most equitable rate
as you move from timed to untimed codes.
Contacting the Health Plan
If you currently use CPT codes with time units for billing
purposes, you may consider contacting the health plan to review
this policy and, in the process of converting from timed to untimed
codes, advocate for the most equitable payment rate based on a
typical length of service. As stated under the first strategy, you
should consider contacting your STAR network representative and
discuss a conversion to a per-session descriptor from a state
association perspective rather than that by an individual
practitioner.