If you are billing for SGD-related services (CPT 92609), you would list 92609 on the first line of the form and then 92507 with a -59 modifier to indicate that they are distinct services. No such modifier is needed when billing 92607 for non-SGD services on the same day as 92507.
- Modifier GN will be appended with CPT 92507 for SLP (Speech-language Therapy) when billed to medicare Part-B service.
- Modifier 22 will be attached with the service CPT 92507 when the service is performed longer than generally required for speech therapy.
Is CPT code 92507 for individual or group?
We are having the same problem in the CPT AMA code book it say's that the code 92507 treatment of speech , language, voice , communication is for individual. The 92508 is in group, 2 or more individuals so it looks as if you would be bundled.
When should I use 92507 or 92606?
You should use 92507, because you are providing speech-language treatment. You should use 92606 or 92609 only if you are working with the patient on how to use the device itself and/or are modifying or programming it for their use.
Do I need prior authorization for a 92507 claim?
See “Other Instructions” for 92507. Prior authorization is always required. Prior authorization is always required. on separate claim lines. prior authorization. Prior authorization is always required. Prior authorization is always required. See “Other Instructions” for 92507. 1.
Can 92523 and 96125 be billed in the same session?
Can 92523 and 96125 be billed in the same session; i.e. does modifier 59 allow same discipline to charge both in same session if done at distinct times. The same discipline can bill both those codes the same visit as long as documentation supports both.
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 CPT code 92507 need 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.
How do I bill a CPT 92507?
AP treatment should be coded under CPT 92507, the code for speech, language, voice, communication, and/or auditory processing disorder treatment.
Is CPT code 92507 A timed code?
Can procedure codes be billed by units of time? Most speech-language pathology codes do not have time units assigned to them, such as 92507 (speech-language treatment).
Can 92507 and 97110 be billed together?
Although not all code pairs are explicitly listed in the CCI edits, Chapter 11, Section H-2 of the Medicare NCCI Policy Manual states that SLPs can't report "CPT codes 97110, 97112, 97150, 97530, 97129 as unbundled services included in the services coded as 92507, 92508, or 92526".
What is a 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.
How do you bill for a modified barium swallow study?
CPT codes 70370, 70371 and 74230 describe the complete barium swallow study and should only be billed one time per patient on the same date of service. Only one of these CPT codes should be billed per patient on the same date of service.
What is the CPT code for modified barium swallow study?
CPT code – 70370, 70371, 74230 – Barium Swallow Studies, | Medicare Payment, Reimbursement, CPT code, ICD, Denial Guidelines.
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.
Is 92507 a speech therapist?
92507 — Treatment of speech, language, voice, communication, and/or auditory processing disorder. Code 92507 is used for therapy services that pertain to auditory rehabilitation, voice prosthetics, and communication and/or cognitive impairments.
What are modifiers GP Go GN?
Modifiers GN, GO, and GP refer only to services provided under plans of care for physical therapy, occupational therapy and speech-language pathology services. They should never be used with codes that are not on the list of applicable therapy services.
What is the CPT code for speech and language evaluation?
Currently, CPT code 92506 is billed for the evaluation of speech, language, voice, communication, and/or auditory processing.
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.
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.
What does GN mean in CMS?
Note: CMS requires that the "- GN " modifier be added to every code that is rendered under a speech-language pathology or dysphagia plan of treatment (-GO indicates occupational therapy; -GP indicates physical therapy).
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.
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.
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.
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.
What is CPT code 92609?
No. Code 92609 is used to report therapeutic services provided by the clinician for use of speech-generating devices. Programming and modifications necessary for the device are included as part of the procedure and are, therefore, not separately reported. CPT 96125 is "standardized cognitive performance testing.".
What is CPT 92611?
CPT 92611 is the procedure represents the speech-language pathologist's participation in the MBS or videofluoroscopy. A separate radiology procedure code, CPT 74230 covers the services of the radiologist and the radiology technician.
What is the code for cognitive function intervention?
Medicare 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 91729/97130 could be used, but not both on the same day by the same provider.
Does Medicare reflect current market rates?
It is important for you to know that Medicare rates reflect a budgetary constraint and may not reflect current market rates. You can also purchase historic fee data from medical coding publishers. Discussing fees with other local practices may be construed as price-fixing.
Do health plans require documentation?
Payers may have documentation requirements of their own, including the information they want to see when reviewing a claim and the timelines in which documentation must be submitted. Typically, health plans are instructed by law to initially request only the minimum information necessary to pay a claim.
Is speech language pathology a reimbursable service?
Often, private health plans develop policies that are consistent with those of Medicare. Under Medicare, services provided by speech-language pathology assistants are not considered medically necessary and therefore are not reimbursable.
Can you use 92000 code with 97000 code?
Using a 92000 code in combination with a 97000 code may constitute unbundling of codes, and is not allowed. Unbundling is when you code one component of a treatment separately when that component is already captured under a more comprehensive code that you are also using. See also: Use of Physical Medicine Codes.
Why use 92507?
You should use 92507, because you are providing speech-language treatment . You should use 92606 or 92609 only if you are working with the patient on how to use the device itself and/or are modifying or programming it for their use.
What is a 92609 code?
92609, Therapeutic services for the use of speech-generating device, including programming and modification. For ongoing speech and language treatment, use: 92507, Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual. Medicare does not reimburse for codes specific to evaluation or treatment ...
How often should I bill for a medical evaluation?
Check with your payer when in doubt. In this case, you should consider billing for only one evaluation, even though it spans multiple days. When submitting the claim, wait until you have completed the entire evaluation and bill based on the last date of service you saw the patient for the evaluation.
Can you bill Medicare and Medicaid on the same day?
According to Medicare and Medicaid’s National Correct Coding Initiative (NCCI), which many other payers also follow, the codes may be billed together on the same day—but your documentation must demonstrate that you are providing two distinct and separate services.
Does Medicare reimburse for speech generating devices?
Medica re does not reimburse for the codes specific to evaluation or treatment for non-speech-generating devices . Medicare views these codes as bundled with other services that the SLP would already be performing, such as speech-language evaluation or treatment. For example, Medicare considers the non-speech-generating device evaluation as part ...
What is 92507 used for?
For treatment of auditory processing disorders or auditory rehabilitation/auditory training (including speech-reading or lip-reading), 92507, and 92508 are used to report a single encounter with “1” as the unit of service , regardless of the duration of the service on a given day.
Can a PC be billed by a technician?
The PC may not be billed if a technician furnishes the service. A physician or NPP may not bill for a PC service furnished by an audiologist. *The TC of a PC/TC split code may be billed by the audiologist, physician, or NPP who personally furnishes the service.
Can a physician bill for a TC?
Physicians may bill the TC for services furnished by technicians when the technician furnishes the service under the direct supervision of that physician. Audiologists and NPPs may not bill for the TC of the service when a technician furnishes the service, even if the technician is supervised by the NPP or audiologist.
Designation of Time
Code Modifiers
Same-Day Billing Restrictions
Use of Physical Medicine Codes
Additional Resources
Cpt Codes & Special Medicare Rules For Slps
- Table 1: Services and Procedures Covered Under the Therapy Benefit
Note: CMS requires that the "-GN" modifier be added to every code that is rendered under a speech-language pathology or dysphagia plan of treatment (-GO indicates occupational therapy; -GP indicates physical therapy). - Table 2: Other CPT Codes of Interest to Speech-Language Pathologists
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 …