On December 13, 2013, the Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 8539 [PDF], which provides the quarterly update of Health Care Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes for home health consolidated billing. The update addresses new codes, slated to become effective January 1, 2014, but overlooked for the 1st quarter update in 2014. Overlooked codes include the four new speech-language pathology CPT codes:
- 92521, Evaluation of speech fluency (e.g., stuttering, cluttering);
- 92522, Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria);
- 92523, Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language);
- 92524, Behavioral and qualitative analysis of voice and resonance.
Though CR 8539 indicates that new codes will not be active for home health consolidated billing until April 1, 2014, the change code actually relates to specific edit issues in the claims processing system and does not affect the ability for speech-language pathologists to begin billing the codes on January 1, 2014, regardless of setting. Additionally, this issue is specific to home health consolidated billing and does not apply to fee-for-service (Medicare Part B) billing.
CMS periodically updates the lists of HCPCS and CPT codes that are subject to the consolidated billing provision of the Home Health Prospective Payment System (HH PPS). With the exception of therapies performed by physicians, supplies incidental to physician services, and supplies used in institutional settings, services appearing on this list that are submitted on claims to Medicare Administrative Contractors (MACs) will not be paid separately on dates when a beneficiary for whom such a service is being billed is in a home health episode (i.e., under a home health plan of care administered by a home health agency).
Additional information on use of the new evaluation codes is available on ASHA's Billing & Reimbursement website.
Questions may be addressed to ASHA's health care economics and advocacy team at firstname.lastname@example.org.