Medicare Reimbursement of Speech-Language Pathology Services
Speech-language pathology services under Medicare Part B have reimbursement rates established by the Medicare Physician Fee Schedule regardless of provider setting. Payment is determined by the fee associated with a specific procedure code in those settings. The fee schedule is updated annually.
Payments for outpatient therapy services are subject to a combined targeted medical review threshold of $3,000 for speech-language pathology and physical therapy and a separate cap for occupational therapy.
Coding
- Coding for Reimbursement
- Coding Systems
- Learn About Timed & Untimed Codes
- Medicare Coding Rules: Speech-Language Pathology
- National Correct Coding Initiative (CCI) Edits and Medically Unlikely Edits (MUEs)
Billing & Documentation
- Overview of Documentation for Outpatient Therapy Services
- Medicare Part B Claims Checklist: Avoiding Simple Mistakes on the CMS 1500 Form
- Step-by-step instructions for the CMS 1500 form [PDF]
- CMS 1500 Health Insurance Claim Form [PDF] - Sample only
- Health Insurance Portability & Accountability Act (HIPAA)
Medicare Part B Therapy Review Process
- Medicare Part B Review Process for Therapy Claims
- Overview of Documentation for Outpatient Therapy Services
- CMS Therapy Services Homepage
Fraud & Abuse
- Issues in Ethics Statement: Reimbursement
- Summary of Self-Referral (Stark Law) and Anti-Kickback Regulations
- Self-Referral (Stark Law) and Anti-Kickback Regulations: Q & A
- CMS Physician Self-Referral Information
Other Resources
- ASHA's State Advocates for Medicare Policy (StAMP) Network (one of the ASHA State-Based Advocacy Networks)
- CMS Medicare Physician Fee Schedule Look Up
- CMS webpage on Electronic Billing & EDI Transactions
See also: Medicare Coverage Policies
