New and Revised CPT Codes For 2019

Speech-Language Pathology

The following are additions and deletions to speech-language pathology related Current Procedural Terminology (CPT® American Medical Association) codes, effective January 1, 2019.

New CPT Codes

There are no major changes to CPT codes directly related to speech-language pathology services. However, SLPs who provide early intervention services or services to patients with autism spectrum disorder may need to be aware of the following new CPT codes.

Developmental/Behavioral Testing

These new codes replace CPT code 96111. See "Deleted Codes" below.

96112 Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour

96113 Each additional 30 minutes (List separately in addition to code for primary procedure.)

ASHA Notes
  • 96112 (base code) and 96113 (add-on code) are timed codes. 96112 represents the first hour and 96113 should be billed conjunction with 96112 when testing extends beyond the first hour. Learn more about appropriate billing of timed codes
  • Generally, ASHA recommends these codes when assessing pre-verbal communication in young children. CPT code 92523 (speech and language evaluation), which includes formal and informal testing, typically better describes a comprehensive communication evaluation by a speech-language pathologist.
  • Check with payers regarding use of these codes by a speech-language pathologist.

Adaptive Behavior Assessment and Treatment

97151 Behavior identification assessment, administered by a physician or other qualified health care professional, each 15 minutes of the physician’s or other qualified health care professional’s time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan

97152 Behavior identification–supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes (For speech evaluations, see 92521, 92522, 92523, 92524)

97153 Adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with one patient, each 15 minutes (Do not report 97153 in conjunction with 90785-90899, 92507, 96105-96155)

97154 Group adaptive behavior treatment by protocol, administered by technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes  (Do not report 97154 if the group has more than 8 patients)  (Do not report 97154 in conjunction with 90785-90899, 92508, 96105-96155, 97150)

97155 Adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes (Do not report 97155 in conjunction with 90785-90899, 96105-96155, 92507)

97156 Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (with or without the patient present), face-to-face with guardian(s)/caregiver(s), each 15 minutes (Do not report 97156 in conjunction with 90785-90899, 96105-96155)

97157 Multiple-family group adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of guardians/caregivers, each 15 minutes (Do not report 97157 if the group has more than 8 families) (Do not report 97156, 97157 in conjunction with 90785-90899, 96105-96155)

97158 Group adaptive behavior treatment with protocol modification, administered by physician or other qualified health care professional, face-to-face with multiple patients, each 15 minutes (Do not report 97158 if the group has more than 8 patients) (Do not report 97158 in conjunction with 90785-90899, 96105-96155, 92508, 97150)

ASHA Notes:
  • This new set of CPT codes describes services typically provided by qualified health care professionals trained in applied behavioral analysis (ABA).
  • Check with payers to determine whether these services are covered and what provider types are eligible to report these codes.

Deleted CPT Codes

96111 Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments) with interpretation and report

Revised CPT Codes

No speech-language pathology codes have been revised for 2019.

See also:

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