Unlike physical therapists and occupational therapists, speech-language pathologists were not recognized as providers who could directly bill the Medicare program until July 16, 2008, when the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 was passed. MIPPA included a provision that allows speech-language pathologists in private practice to directly bill the Medicare program effective July 1, 2009. For more information go to Medicare & Speech-Language Pathologists in Private Practice.
Speech-language pathologists enrolled in the Medicare program are no longer subject to the "incident to" rule, may see patients without the direct supervision of a physician, and should use their own Medicare numbers when submitting reimbursement for their services, even if they work in a physician office/group.
Speech-language pathologists who do not wish to be enrolled in the Medicare program may still provide services to Medicare beneficiaries by contracting with a physician's office and following the "incident to" rules, as outlined below. The Medicare program allows "auxiliary personnel" (non-physician employees and independent contractors) to bill under a physician's provider number. This billing practice is permissible as incident to physician services. In order for the services to be billable as incident to:
Some steps to consider in contracting with a physicians office include:
CMS affirmed that current qualification and training standards for therapists under Medicare apply to services rendered by employees or contractors of physicians. CMS adopted a new regulation, 42 CFR 410.62, "Outpatient speech-language pathology services: Conditions and exclusions" that references speech-language pathology qualifications for home health agency conditions of participation (42 CFR 484.4):
Speech-language pathologist . A person who:
Medicare rules require that a physician, physician assistant (PA), nurse practitioner (NP), or clinical nurse specialist (CNS) be in the office suite when therapy services are rendered. In States that authorize physicians, PAs, NPs, and CNSs to provide one or more therapy services, they need not meet the training requirements applicable to therapists.
Again, only speech-language pathologists in physician offices who are not enrolled as Medicare providers are subject to the "incident to physicians' services" rule. Speech-language pathologists who do not wish to contract with a physician's office may bill Medicare directly by becoming a Medicare provider and establishing their own private practice.
For additional information on Medicare billing and coverage, contact ASHA's Health Care Economics and Advocacy Team at firstname.lastname@example.org.