New and Revised CPT Codes For 2018
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).
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
- This code is untimed
and can only be billed once per day regardless of the length of the session.
- Medicare will not accept this new code and is replacing it with its own 15-minute
G-code for cognitive therapy. See ASHA's 2018 Medicare Fee Schedule for SLPs, published in early November, for
- 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.
Like its predecessor, 97127 may 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.
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
ASHA Note: 97532 will be replaced by CPT code 97127, effective January 1, 2018 (see above).
Revised CPT Codes
No speech-language pathology codes have been revised for 2018.
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.
- 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.