Can an SLP bill Medicare directly?
Enrollment will allow SLPs in private practice to bill Medicare and receive direct payment for their services. Previously, the Medicare program could only pay SLP services if an institution, physician or nonphysician practitioner billed them.
How do you bill a speech therapist?
CPT Codes Used in Speech Therapy Medical BillingCPT Code 92507: Auditory Processing Disorders.CPT Code 92523: Speech Sound Production and Expressive Language.CPT Code 92521: Evaluation of Speech Fluency.
Can 92507 and 97129 be billed together?
SLPs can't pair most codes in the physical medicine series (e.g., 97129) with a speech-language pathology related code (e.g., 92507).
What is the modifier for 92507?
CPT 92507 will be reported with modifier XK if the physician attests that therapy is performed longer than usual due to exceptional circumstances and medical documentation supporting this service and medically appropriate.
How do I bill a Medicare speech pathologist?
SLPs may use 97000 series CPT codes—if appropriate. Under Medicare, SLPs may use CPT codes 97129 (cognitive function intervention, initial 15 minutes) and 97130 (cognitive function intervention, each additional 15 minutes) when treating cognitive disorders.
What is GN modifier?
Definitions. Modifier GN: Services delivered under an outpatient speech language pathology plan of care. Modifier GO: Services delivered under an outpatient occupational therapy plan of care. Modifier GP: Services delivered under an outpatient physical therapy plan of care.
Does modifier go on column1 or column 2 code?
Effective July 1, 2019, Medicare allows placement of modifier 59 and the X{EPSU} modifiers on either the column 1 or column 2 code of a Correct Coding Initiative (CCI) edit pair to bypass the edit. This is a change from the previous rule requiring placement of those modifiers on the column 2 code.
What can be billed under 92507?
AP treatment should be coded under CPT 92507, the code for speech, language, voice, communication, and/or auditory processing disorder treatment.
Who can bill CPT code 97129?
PsychologistsPsychologists must now use the stand-alone base code, 97129, to report the first 15 minutes of performing the primary service, and a 15-minute add-on code, 97130, which can be reported in multiple units, to report additional time (beyond the initial 30 minutes) required to complete the overall service.
Is 92507 covered by Medicare?
Use 92507 for training and modification of voice prostheses. Medicare won't pay for this code because it is considered bundled with any other speech-language pathology service provided on the same day. SLPs may not separately bill for non-speech-generating device services alone.
Does 92507 require a modifier?
Procedure codes 92507, 92526, 92630, 92633, and 97535 require modifier GN. Speech therapy treatment will be denied when billed by any provider on the same day as a speech therapy evaluation or reevaluation.
Can 92507 and 97153 be billed together?
Claims for procedure codes 97153 and 92507 are denying against each other in error with error code 6100 (Invalid combination of procedures the same day) when billed by any provider approved to bill the services for the same recipient for the same date of service.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Speech-Language Pathology.
ICD-10-CM Codes that Support Medical Necessity
The correct use of an ICD-10-CM code does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the related determination.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
What happens if you don't meet the medical necessity for speech therapy?
Medical necessity has not been met for billing speech therapy: If medical necessity is not met, the insurance company will deny the claim. All services rendered must be met by medical necessity and have the appropriate ICD-10-CM diagnosis code. If the diagnosis code cannot show the likelihood of the condition or injury, the insurance company will not consider the service appropriate.
What is documentation in speech?
Documentation must include: The ability to execute motor movements needed for speech. Written comprehension and verbal expression. A determination of the patient’s ability to create and communicate expressive thought. An evaluation of the patient’s ability to produce speech sounds.
What is a speech evaluation?
An evaluation of the patient’s ability to produce speech sounds. The physician takes a patient history, including speech and language development, hearing loss, and physical and mental development, and performs a physical examination. Speech and language evaluations are conducted.
What is the Medicare Benefit Policy Manual?
The Medicare Benefit Policy Manual provides general coverage rules and regulations for providers of Medicare services. Specifically, Chapter 15, Section 220-230.6 [PDF] of the manual addresses the rules and regulations related to therapy services (speech-language pathology, physical therapy, and occupational therapy) provided in an outpatient setting.
How many coding systems are there for Medicare?
There are three major coding systems used when submitting claims for reimbursement by Medicare. Below are links to speech-language pathology related codes compiled from each of the major coding systems:
What is the CMS 1500 form?
Medicare billing is coordinated through your local Medicare contractor, however, the standard form used for submitting claims is called the CMS 1500 Health Insurance Claim Form [PDF]. For step-by-step instructions on completing and processing the CMS 1500 form, go to Chapter 26 of the Medicare Claims Processing Manual [PDF].
Does Medicare have coding rules?
Medicare Coding Rules. Medicare has very specific rules regarding coverage of certain codes and services . ASHA has compiled Medicare coding rules related to speech-language pathology services, however, you should also be aware of local coverage determinations (LCDs) from Medicare contractors that are specific to your locality.
Does Medicare pay for speech pathology?
Speech-language pathology services under Medicare Part B have reimbursement rates established by the Medicare Physician Fee Schedule regardless of provider setting. Payment is determined by the fee associated with a specific procedure code (see Coding for Reimbursement) in those settings. The fee schedule is updated annually.
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L35070 Speech-Language Pathology (SLP) Services: Communication Disorders. Please refer to the LCD for reasonable and necessary requirements.
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
ICD-10-CM Codes that DO NOT Support Medical Necessity
All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
How long does it take for a speech pathologist to recertify a plan of care?
If the plan of care is written by the speech-language pathologist, it must be certified by the patient's physician within 30 days. For outpatient services, the plan of care must be recertified by the physician every 90 days from ...
How often do you have to recertify a plan of care?
For outpatient services, the plan of care must be recertified by the physician every 90 days from the initiation of treatment or when there is a significant modification to the plan. The physician must review the plan of care every 60 days for home health agencies and Comprehensive Outpatient Rehabilitation Facilities.
What is the code for cognitive function intervention?
Medicare policy specifically allows speech-language pathologists to use 97129 (cognitive function intervention, initial 15 minutes) and 97130 (cognitive function intervention, each additional 15 minutes) for treatment of cognitive disorders, but notes that either code 92507 or 97129/97130 could be used, but not both for the same treatment.
Why do not use other physical medicine codes?
Additionally, officials at the Centers for Medicare and Medicaid services do not support the use of other physical medicine codes because the vignettes (examples of the procedures performed with a typical patient) used reflect physical therapy or occupational therapy.
Can a speech pathologist change a plan of care?
The physician or speech-language pathologist can make changes in the plan of care. The speech-language pathologist may not significantly alter a plan of care without recertification from the physician. Medicare requirements for a plan of care are set forth in the Medicare Benefit Policy Manual, Chapter 15, Section 220.1.2 [PDF].
Is speech language pathology covered by Medicare?
Services of speech-language pathology assistants are not recognize d for Medicare coverage. Services provided by speech-language pathology assistants, even if they are licensed to provide services in their states, will be considered unskilled services and denied as not reasonable and necessary if they are billed as therapy services. Services provided by aides, even if under the supervision of a therapist, are not therapy services and are not covered by Medicare. Although an aide may help the therapist by providing unskilled services, those services are not covered by Medicare and shall be denied as not reasonable and necessary if they are billed as therapy services.
Is a therapist covered by Medicare?
Services provided by aides, even if under the supervision of a therapist, are not therapy services and are not covered by Medicare. Although an aide may help the therapist by providing unskilled services, those services are not covered by Medicare and shall be denied as not reasonable and necessary if they are billed as therapy services.
How much is speech therapy for Medicare 2021?
For 2021, the allotted amount for speech-language pathology services is $2,110 . But—and this is a big “but”—that amount also includes any physical therapy services a Part B beneficiary receives throughout the year. For any claims that exceed this threshold, providers must affix the KX modifier to denote the medical necessity of continued treatment and thus, receive reimbursement for additional services.
How long does it take for a speech pathologist to be certified?
However, as ASHA explains here, the plan of care “must be certified by the patient’s physician within 30 days.
What CPT code do physical therapists use?
But, you may not know that SLPs can use these codes as well. Under Medicare, SLPs may use CPT codes 97129 (cognitive function intervention, initial 15 minutes) and 97130 (cognitive function intervention, each additional 15 minutes) when treating cognitive disorders. However, as ASHA notes here, “either code 92507 or 91729/97130 could be used, but not both on the same day by the same provider.”
Is Medicare a good place to start?
The Medicare fee schedule for your region is a good place to start. Of course, Medicare’s fee schedule may not reflect the current market rates, so we also recommend seeking guidance from your local peers and your state-level speech therapy organization.
Does Medicare cover clinical fellows?
The rules are a little different for clinical fellows. According to ASHA, “This student policy does not apply to clinical fellows practicing in States that grant clinical fellows temporary or provisional licensure…However, in States without such licensure, Medicare treats clinical fellows as graduate students requiring ‘in the room’ supervision.”
Does Medicare pay for student led services?
Medicare will not pay for student-led services.
Is student participation in a service reimbursable?
That said, student participation in a service does not automatically make it non-reimbursable. Section 230.B goes on to state that students may assist in services rendered by a licensed SLP or deliver services under the direct guidance and supervision of the licensed provider.
What is the CPT code for speech pathology?
Speech language pathologists may perform services coded as CPT codes 92507, 92508, or 92526. They do not perform services coded as CPT codes 97110, 97112, 97150, or 97530, which are generally performed by physical or occupational therapists.
How often are CPT codes billed?
Most CPT/HCPCS codes reported by speech-language pathologists are untimed and do not include time designations in the code descriptor. An untimed code is billed once per day, regardless of the time spent providing the service. On the other hand, timed codes include a time designation in the descriptor (for example, "per hour", "first hour", "initial 15 minutes", "each additional 30 minutes") and may be billed multiple times per day to represent the amount of time spent in direct patient care. Bill a timed only when face-to-face time spent in evaluation or treatment is at least 51% of the time designated in the code's descriptor. An exception is 96125, where allowable time includes interpretation of test results and preparation of the report.
What is a modifier in CPT?
Code modifiers are appended to a CPT or HCPCS code to provide additional information about the service provided. For example, untimed codes may include modifiers to represent atypical procedures. Untimed CPT codes represent the "typical" time it takes to complete a specific evaluation or treatment. For significantly atypical procedures, a -22 modifier can be used to indicate that the work is substantially greater than typically required and a -52 modifier for an abbreviated procedure. Modifier -22 should not be used frequently because the Medicare contractor could make the determination that the procedure reflects typical service delivery. Claims with the -22 modifier require an additional description of the need for extended services. Modifiers -22 and -52 may not be used in conjunction with timed codes.
Why is modifier -22 not used?
Modifier -22 should not be used frequently because the Medicare contractor could make the determination that the procedure reflects typical service delivery. Claims with the -22 modifier require an additional description of the need for extended services.
Is speech pathology billed by Medicare?
These procedures are generally not considered to be speech-language pathology codes billable to Medicare, although some may be performed by SLPs "incident to" a physician. This means the SLP's services are billed under the physician's NPI and the physician must be on premises when services are provided.
Does CMS have a policy statement?
Although CMS has not issued a formal policy statement regarding this issue, agency officials have stated their position, based on the official descriptors and vignettes for the codes. Additionally, Chapter 11, Section H-2 of the National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services states.
Does Medicare require a modifier 59?
Medicare publishes National Correct Coding Initiative (CC) edits that may require modifier -59. Medicare Part B services provided under plans of care for speech-language pathology or dysphagia services also require a - GN modifier. The requirement applies to physician offices as well as facilities and private practices.
