Medicare Guidelines for Group Therapy Treatment
Below are guidelines for group therapy treatment from the Medicare Benefit Policy Manual for Part B services. It should be noted that all speech-language pathology Local Coverage Determinations (LCDs) limit group treatment to no more than four patients. This limit is also stated nationally in regard to Part A skilled nursing facility therapy services.
To our knowledge, most Medicare Administrative Contractors (MACs) list CPT 92508 for group speech therapy treatment while one MAC cites CPT 97150 and two cite CPT 92508 for group dysphagia therapy.
Speech-language pathologists should consult LCDs or their MACs for final determinations on appropriate coding for group speech therapy and group dysphagia therapy.
Medicare Benefit Policy Manual, Chapter 15:
230-Practice of Physical Therapy, Occupational Therapy, and Speech-Language Pathology
A. Group Therapy Services. Contractors pay for outpatient physical therapy services (which includes outpatient speech-language pathology services) and outpatient occupational therapy services provided simultaneously to two or more individuals by a practitioner as group therapy services (97150). The individuals can be, but need not be performing the same activity. The physician or therapist involved in group therapy services must be in constant attendance, but one-on-one patient contact is not required.
See reference in the Medicare Benefit Policy Manual [PDF, 1.2MB].
Group Dysphagia Therapy
Some MACs may not have an LCD related to group dysphagia services. In such cases, speech-language pathologists should contact their MAC to discuss options. Below are references that may be cited.
Medicare Outpatient Therapy Billing [PDF, 1.3MB] Article from Medicare Learning Network
Page 5 states that 97150 is appropriate to bill group dysphagia treatment for Part B patients. While this guide is not an official Medicare policy, it is supported by the Medicare Benefit Policy Manual, as cited above.
Local Coverage Determinations from MACs
For more information, contact Mark Kander, Director of Health Care Regulatory Analysis at email@example.com.