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Health Care Billing Codes

Overview

Billing codes are used on health care claims to identify (a) the patient’s treating diagnosis and relevant medical conditions (e.g., speech, language, or hearing disorder; autism spectrum disorder); (b) services provided (e.g., audiometric testing, swallowing intervention); and (c) durable medical equipment and devices supplied (e.g., hearing aids, speech-generating devices). ASHA monitors changes in clinical practice patterns and in public and commercial health care payment to ensure that audiologists and speech-language pathologists (SLPs) have access to the range of billing codes that accurately describe the patients they see and the services they provide.

ASHA’s advocacy efforts focus on leading code development and maintenance initiatives across the major code sets—Current Procedural Terminology (CPT®), the International Classification of Diseases (ICD), and the Healthcare Common Procedures Coding System (HCPCS) Level II—including (a) working with payers and stakeholders on coding and coverage issues and (b) engaging in the CPT code development and valuation process on behalf of audiologists and SLPs. This important process informs Medicare outpatient payment, which often has a direct impact on other payers, including commercial insurers and state Medicaid programs.

Impact on Everyday Practice

Billing codes set a universal language among health care providers, including audiologists and SLPs; people who bill for health care services, such as hospital coders or office managers; and the payers that cover and reimburse for the services, such as public programs like Medicare and Medicaid as well as commercial insurers like UnitedHealthcare or Blue Cross Blue Shield. The Health Insurance Portability and Accountability Act (HIPAA) also requires use of uniform billing code sets for all health care electronic transactions.

Audiologists and SLPs use billing codes on health care claims to justify medical necessity and to receive reimbursement for services provided. Even clinicians who may not be directly responsible for billing should be aware of health care coding policies and guidelines because they are ultimately responsible for services reported on the claim. Clinicians who know how to correctly code and bill for their services are attractive to potential employers, use their knowledge to prevent incorrect or fraudulent billing practices, and help their patients get the timely and appropriate care they need.

Stay Informed. Get Involved

ASHA’s Advocacy on Billing Codes

ASHA advocates for comprehensive coverage and equitable reimbursement for audiologists and SLPs across payers. Following are comments submitted on issues impacting audiologists and/or SLPs.

Questions?

Contact ASHA staff at reimbursement@asha.org

ASHA Corporate Partners