New and Revised CPT Codes For 2018

Speech-Language Pathology

The following are additions and deletions to speech-language pathology related Current Procedural Terminology (CPT) codes and modifiers, effective January 1, 2018.

New CPT Codes

The following new CPT code will replace current CPT code 97532 (cognitive skills development, each 15 minutes).

97127 Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact

ASHA Notes:
  • This code is untimedand can only be billed once per day regardless of the length of the session.
  • Medicare will not accept CPT code 97127 and is replacing it with its own 15-minute G-code, G0515, for cognitive therapy. See New Medicare G-code below for additional information.
  • Check with non-Medicare payers regarding implementation of 97127. You should also make sure reimbursement rates are reflective of a session, and not 15 minute units. 
  • Contact reimbursement@asha.org if you find a payer is incorrectly implementing 97127.

Deleted CPT Codes

97532 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes

Revised CPT Codes

No speech-language pathology codes have been revised for 2018.

Other Changes

New Medicare G-code for Cognitive Treatment

G0515 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes

ASHA Notes:
  • Medicare will not accept new CPT code 97127 (Cognitive function intervention). Medicare has created G0515 to report cognitive treatment instead.
  • G0515 mirrors former CPT code 97532 and should be reported on the claim form exactly as 97532 would have been, and in 15-minute units. 
  • Like 97532, G0515 should not be billed with CPT code 92507 (speech, language, voice, communication treatment). Review  Correct Coding Initiative (CCI) edits for more information on same-day billing of CPT codes.
  • Non-Medicare payers (i.e., Medicaid, Medicare Advantage or Part C, and private health insurance) may choose to implement either G0515 or 97127. Check with each non-Medicare payer to verify which code they will implement for cognitive treatment.
  • Contact reimbursement@asha.org if you find that a payer is incorrectly implementing a new code for cognitive treatment.

See ASHA's  2018 Medicare Fee Schedule for SLPs, published in mid-November, for further details.

New CPT Code Modifiers

The following new CPT code modifiers can be used to delineate whether a service is habilitative or rehabilitative in nature.

Modifier 96 (Habilitative services)
When a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. Habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. Habilitative services also help an individual keep, learn, or improve skills and functioning for daily living.

Modifier 97 (Rehabilitative services)
When a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. Rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled.

ASHA Notes:
  • Affordable Care Act (ACA) compliant plans may use these new modifiers to track habilitative and rehabilitative benefits.
  • These new modifiers will not replace existing modifier SZ (habilitative services).
  • Check with your payers regarding implementation of the new modifiers.

See also:

ASHA Corporate Partners