ASHA suggests that speech-language pathologists take a proactive approach using the following strategies when you are advised by payers that there are no time components associated with most speech-language pathology and audiology CPT codes.
Important: Setting prices with input from your competitors is illegal. Avoid price fixing by refraining from activities such as discussing charges for speech-language pathology procedures with your peers.
If you choose and can negotiate the continuance of billing in time units, you should obtain written verification from the health plan about the policy allowing this. Please remember, however, that the Center for Medicare Management (CMM) at the Centers for Medicare and Medicaid Services (CMS) will not allow the addition of time units and that the CPT policy does not designate time units for the codes in question. It is up to you and the health plan to agree to use time units. You should consider contacting ASHA State Advocates for Reimbursement (STAR) Network (one of the ASHA State-Based Advocacy Networks). An organized state speech-language-hearing association response to a revision in payment policy can be more fruitful than that by a single speech-language pathologist.
If you are audited and asked to make a refund, realize that there are resources to assist you in defending past practices of using timed codes. You can appeal the health plan decision or file a grievance (check with the health plan's policies) and a compromise may be reached (as clinician Kathleen Helfrich-Miller writes about in the June 19, 2007 ASHA Leader, volume 12, number 8, pages 18-19). Confirm that changes to using untimed codes also need to be made and negotiate for the most equitable rate as you move from timed to untimed codes.
If you currently use CPT codes with time units for billing purposes, you may consider contacting the health plan to review this policy and, in the process of converting from timed to untimed codes, advocate for the most equitable payment rate based on a typical length of service. As stated under the first strategy, you should consider contacting your STAR network representative and discuss a conversion to a per-session descriptor from a state association perspective rather than that by an individual practitioner.