New and Revised CPT Codes for 2020
The following are additions, revisions, and deletions to Current Procedural Terminology (CPT® American Medical Association) codes for speech-language pathologists, effective January 1, 2020.
New CPT Codes
The following new CPT codes are effective January 1, 2020.
97129 Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes (Report 97129 only once per day)
97130 each additional 15 minutes (list separately in addition to code for primary procedure)
(Use 97130 in conjunction with 97129)
(Do not report 97129, 97130 in conjunction with 97153, 97155)
- 97129 (base code) and 97130 (add-on code) are time-based codes. They replace CPT code 97127 and HCPCS G-code G0515. See "Deleted Codes" below.
- 97129 represents the first 15 minutes of therapy. Report 97130 in conjunction with 97129 when therapy extends beyond the first 15 minutes.
Learn more about correct billing of timed codes.
- Payer policies and coding rules for cognitive therapy will likely stay the same, including
- Contact email@example.com if a payer is incorrectly implementing the new codes for cognitive therapy.
Nonphysician Online Digital Evaluation and Management (E/M) Service
98970 Qualified nonphysician health care
professional online digital evaluation and management service, for an
established patient, for up to 7 days, cumulative time during the 7 days; 5-10
98971 11–20 minutes
98972 21 or more minutes
98970, 98971, 98972 once per 7-day period)
not report online digital E/M services for cumulative visit time less than 5
(Do not count 98970, 98971, 98972 time otherwise
reported with other services)
- It is important to check with payers regarding use of these codes. Many payers do not cover E/M services provided by qualified nonphysician health care professionals, such as speech-language pathologists. Learn more about billing E/M codes.
- In the 2020 Medicare Physician Fee Schedule final rule, Medicare finalized similar G-codes for nonphysician practitioners (e.g., nurse practitioner, physician assistant) and clarified that these services are not covered by Medicare when provided by audiologists and SLPs.
- To correctly report, an online digital E/M service must be
- initiated by an established patient,
- unrelated to a previous evaluation or treatment session provided within the last seven days,
- conducted through a HIPAA-compliant platform, and
- medically necessary (requires clinical decision making and is not for administrative or scheduling purposes).
- These services do not represent real-time interactions and do not replace evaluation or treatment services described by existing CPT codes.
- Documentation of clinical decision making and storage of the exchange are required.
Revised CPT Codes
The following revisions are effective January 1, 2020.
92626 Evaluation of auditory function for surgically
implanted device(s) candidacy or postoperative status of a surgically implanted
device(s); first hour
92627 each additional 15 minutes (list separately in
addition to code for primary procedure)
(Use 92627 in conjunction with 92626)
(When reporting 92626, 92627, use the face-to-face time
with the patient or family)
not report 92626, 92627 in conjunction with 92590, 92591, 92592, 92593, 92594,
92595 for hearing aid evaluation, fitting, follow-up, or selection)
- Use CPT codes 92626 and 92627 to report an evaluation to determine candidacy for a surgically implanted hearing device (for example, a cochlear implant or an osseointegrated implant) or for post-surgical evaluation of performance.
- These codes may no longer be used for activities unrelated to an implant, such as an auditory function evaluation before or after a patient receives hearing aids or other assistive technology.
- These codes may not be billed with CPT codes 92590-92595 for hearing aid services provided to a single patient on the same day. However, the same restrictions aren’t in place for corresponding V-codes or if the services are provided by different clinicians on the same day.
- 92626 (base code) and 92627 (add-on code) continue to be time-based codes. 92626 represents the first hour of evaluation. Report 92627 in conjunction with 92626 when the evaluation extends beyond the first hour. Learn more about correct billing of timed codes.
- Remember to check each payer for policies related to
Deleted CPT Codes
The following CPT codes are deleted effective January 1, 2020.
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 (Report 97127 only once per day)
G0515 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 15 minutes
- ASHA can confirm deletion of CPT code 97127 and HCPCS code G0515, effective January 1, 2020.
- See "New CPT Codes" above for new cognitive therapy codes.