Medicare and Speech-Language Pathologists in Private Practice Frequently Asked Questions

Am I required to enroll as a Medicare provider in order to see Medicare beneficiaries?

If you are providing outpatient services to patients who qualify for Medicare—by virtue of age or disability—under Part B of the Medicare program and you are working in a clinic, office, or private practice setting, federal law requires you to enroll in and bill the Medicare program for covered services provided to Medicare beneficiaries. This means speech-language pathologists will need to get a national provider identifier (NPI) and complete the Medicare enrollment application(s). Once approved, in most circumstances, the clinician must submit claims to Medicare and can only collect applicable co-payments and deductibles from Medicare beneficiaries. For additional information, see ASHA's guidance regarding Medicare enrollment requirements [PDF].

What should I do to become a Medicare provider?

As a first step, speech-language pathologists interested in enrolling in the Medicare program should obtain a National Provider Identifier (NPI), if they have not already done so. CMS offers more information on the NPI, including a general overview and how to apply. For more information on how to become a provider, go to ASHA's section on Medicare and Speech-Language Pathologists in Private Practice.

How do I find out how much Medicare pays for different procedures?

Speech-language pathologists in private practice will be reimbursed based on the Medicare Physician Fee Schedule (MPFS). ASHA's annual analysis of the MPFS rules provides information on procedures specific to speech-language pathologists related to the Medicare fee schedule.

Do I have to have an office to bill Medicare?

No. If the patient is not being treated under Part A of the Medicare benefit (i.e., inpatient or home health services), then the speech-language pathologist can treat a patient in his or her home. However, the place of service(POS) code on the claim form should reflect where the service was delivered. Additionally, speech-language pathologists should keep in mind that transportation costs—such as gas or time spent traveling to the patient's home—cannot be billed to Medicare.

Will I be able to bill Medicare for private practice speech-language pathology services that I provide to Medicare patients in a hospital, SNF, or home health agency?

No. Those services are bundled into the prospective payment to the institution or paid to the home health agency per episode of care. Private practitioners can contract with hospitals, SNFs, or home health agencies, but the facilities are required to bill Medicare directly.

Will I need a physician's order to see a Medicare patient?

The Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 allows speech-language pathologists to enroll as a Medicare provider. A physician order or referral is not required (unless required under state law), although the physician must approve the plan of care within 30 days and periodically thereafter. These Medicare required physician services can be rendered by a nurse practitioner or a physician assistant if consistent with state and local laws. Please visit ASHA's website for additional information on Medicare oversight rules that are contained in the Medicare Benefit Policy Manual.

I am dually certified and would like to enroll in Medicare as both an audiologist and a speech-language pathologist. How should I apply?

Dually certified audiologists/speech-language pathologists must submit a separate enrollment application for each specialty if you want to enroll as more than one non-physician specialty type. You will use the same NPI number for both applications.

Introduction | Enrollment Process | Billing & Coding

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