Effective January 1, 2014, Current Procedural Terminology (CPT, ©American Medical Association) code 92506 (Evaluation of speech, language, voice, communication, and/or auditory processing)was deleted and replaced with four new, more specific evaluation codes related to language, speech sound production, voice and resonance, and fluency disorders.
The codes are:
The following information addresses some of the most commonly asked questions about the new evaluation codes.
The four new evaluation codes were developed by ASHA's Health Care Economics Committee (HCEC) in collaboration with experts in the field from ASHA's Special Interest Groups. The HCEC has been working with the American Medical Association (AMA) to change most speech-language pathology codes since 2009, when a new law took effect that allows private practice SLPs to bill Medicare directly for their services. Because of that change, the AMA's Relative Value Update Committee re-evaluated speech-language pathology codes to include "professional work" value (one of three components of a code's value that reflects the amount of time, technical skill, physical effort, stress, and judgment required to provide the service). Prior to 2009, SLPs were considered "technical support" and their work was included in the "practice expense" component of the code's reimbursement formula. During this process, the RUC recognized that CPT 92506 reflected more than one procedure and requested ASHA to develop specific evaluation procedure codes to replace 92506 and more accurately and appropriately value the professional work performed.
Unlike practice expense, professional work values do not change over time, allowing reimbursement rates for speech-language pathology codes to remain relatively stable.
You should use the new codes for billing patients and filing health insurance claims for services provided on or after January 1, 2014. However, we have heard from SLPs that some payers, including Medicaid programs, have not implemented the new codes, or have incorrectly implemented them. SLPs should attempt to inform their payers regarding the new codes, but should also continue to follow their alternate coding instructions until notified otherwise. You may also contact ASHA at email@example.com for assistance with contacting your payer.
Because CPT 92506 included many different evaluation procedures, SLPs had been paid the same rate whether they provided an evaluation for one disorder or many. The new codes essentially reflect smaller components of the original 92506, so SLPs should expect to see lower payments for each type of evaluation when compared with past payments for 92506.
The Centers for Medicare and Medicaid Services (CMS) has established the national rates for speech-language pathology codes under the Medicare Physician Fee Schedule (MPFS). Other third-party payers generally publish new payment rates after the release of the MPFS in early November, annually. You should contact your payer directly for their current fee schedules.
Yes, SLPs may use these codes for any patient population, as long as they are the codes that are most descriptive of the evaluation being provided. Keep in mind that other evaluation codes—for dysphagia, aphasia, and cognitive performance, among others—are also available for the adult population. A full list of CPT codes available to SLPs can be found on ASHA's billing and reimbursement webpage.
The National Correct Coding Initiative (CCI) establishes edits to control specific code pairs that can or cannot be billed on the same day for Medicare and Medicaid services; CCI edits are also followed by many other third-party payers. Neither the CPT Handbook or the National Correct Coding Initiatives (CCI) edits restrict an SLP's ability to bill the new codes together because there are circumstances when it is appropriate for a patient to be evaluated for multiple disorders on the same day. The exception is the same-day billing of the combination of 92522 and 92523, which is restricted by both the CPT Handbook and CCI edits. There are some combinations with existing codes that the CCI edits require adding a -59 modifier to indicate that the procedures and separate and distinct services.
All new and updated edits are available on ASHA's CCI edits webpage.
In cases where multiple evaluations may be appropriate, documentation should clearly reflect a complete and distinct evaluation for each disorder. Evaluation codes should not be billed for brief assessments that could be considered screenings. Time for identification of other disorders is already built into the value of each code; inappropriate use of multiple evaluations on the same day could result in future restrictions through CCI edits.
If two or more procedures are billed together at least 51% of the time, it is standard to develop a bundled CPT code for that set of services. During the code development process, ASHA surveyed practices and clinics and confirmed that a patient evaluated for language is also evaluated for speech sound production ability more than 80% of the time. However, the reverse is not true. It is common practice for a patient to be evaluated for speech sound production ability independent of a language evaluation, which is why there is a stand-alone code for speech sound production evaluation.
If a patient is evaluated only for language, with no documentation of an assessment of speech (formal or informal), SLPs should bill 92523 with the -52 modifier, which is used when the services provided are reduced in comparison with the full description of the service. Keep in mind that there is also an aphasia assessment code (CPT 96105) that may be appropriate for some adults.
However, SLPs will often address both speech and language throughout the evaluation process, even if only evaluating speech sound production informally. In these instances, SLPs may document that speech sound production is within normal limits and could also provide further detail regarding intelligibility at the sentence and conversational level, as well as explain the results of an orofacial examination for structure and function of articulators. When there is documentation that the SLP used clinical judgment to determine a patient's speech capabilities, billing 92523 without a -52 modifier is appropriate.
No, you may only bill one or the other. A speech sound production evaluation (CPT 92522) is already included as a part of CPT 92523 (speech sound production evaluation with language evaluation).
SLPs should bill CPT 96125 (Standardized cognitive performance testing, per hour) if a complete cognitive standardized test is used and the combined time it takes to conduct the evaluation, interpret the results, and write the report is at least 31 minutes. Sub-tests of standardized tests may be used only if the subtests themselves are standardized.
CPT 96125 may only be billed if standardized testing is part of the evaluation process. If you are providing a cognitive-only evaluation (e.g., memory, attention, executive function) that does not include a communication (i.e., language) component, there is no appropriate alternative for billing.
Payers are increasingly placing emphasis on the use of standardized tests and SLPs are encouraged to include them (e.g., Ross Information Processing Assessment – Second Edition [RIPA-2]) as part of the cognitive evaluation process.
If you are assessing cognitive skills using only non-standardized tools in conjunction with a full speech and language evaluation, you may use CPT 92523. However, speech-language abilities should be the dominant focus.
SLPs may bill an auditory processing disorder evaluation using CPT 92523 with a modifier -52 to indicate that a speech sound production evaluation has not been conducted.
No. There are separate codes for instrumental assessments, such as CPT 92520 for laryngeal function studies.
No. Both of these procedures should be coded using CPT 92597 (Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech)
When evaluating a child’s speech and language abilities, use 92523. If you also complete a full evaluation of that child’s cognitive abilities using standardized cognitive tests, use 96125 and follow the guidelines outlined previously. If you see a very young child, perhaps with multiple impairments, you could consider 96111 (Developmental testing, includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments).
In anticipation of the deletion of 92506, ASHA submitted a letter to the Centers for Medicare and Medicaid Services (CMS) requesting that CPT 92605 (Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour) and CPT 92618 (each additional 30 minutes) be added to the Medicare Physician Fee Schedule (MPFS). However, CMS did not address ASHA's request in the 2014 MPFS. ASHA met with CMS representatives to discuss this issue and CMS made it clear that non-SGD services are considered "bundled" (i.e., not separately billable) and would be captured under any other services the SLP provided that day (e.g, 92523 or 92507). ASHA and CMS are investigating alternatives for those times an SLP would provide a non-SGD service alone. Currently, this would not be billable under CMS' interpretation. ASHA will continue to work with CMS on this issue.
You should start by getting in touch with your payer to ensure they are aware of the coding change. Sometimes, coding systems are not completely updated by the first of the year, causing billing problems.
For Medicare, get in touch with the Medicare Administrative Contractor in your area.
If you continue to have problems, please contact ASHA's health care economics and advocacy team at firstname.lastname@example.org.
Find additional information in these ASHA Leader articles.