What is a modifier for speech therapy?
Modifiers are used to indicate that a service or procedure performed has been altered by some specific circumstance but not changed in its definition or code. The following modifiers may be used when reporting speech-language therapy: Modifier -GN: when Medicare Part B services are provided under plans of care for speech-language pathology.
What are modifiers GN and Kx in speech therapy?
Modifier -GN: when Medicare Part B services are provided under plans of care for speech-language pathology. Modifier -KX: when the clinician attests that services at and above the therapy caps are medically necessary and reasonable, and justification is documented in the patient’s medical record.
What is a modifier in CPT code?
Common CPT Code Modifiers Used in Speech Therapy Medical Billing Modifiers are used to indicate that a service or procedure performed has been altered by some specific circumstance but not changed in its definition or code. The following modifiers may be used when reporting speech-language therapy:
What are the modifiers for Occupational Therapy and physical therapy?
Occupational therapy and physical therapy modifiers are GO and GP, respectively. For therapy services that exceed the outpatient therapy payment trigger, a -KX modifier is required, indicating services are medically necessary and that documentation is available for review.
What modifier do you use for speech therapy?
For physical therapists, use -GP, occupational therapists, use -GO, and speech language pathologists, use -GN.
What is a 21 modifier used for?
CPT Modifier 21 is used when the face-to-face service provided is prolonged or otherwise greater than usually required for the highest level of evaluation and management (E&M) service within a given category.
What is the procedure code for speech therapy?
Speech and Language Pathology Procedure CodesProcedure CodeDescription92507Treatment of speech, language, voice, communication, and/or auditory processing disorder92507 + UC*Treatment of speech, language, voice, communication, and/or auditory processing disorder92508group, two or more individuals24 more rows
What is GN modifier?
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 32 modifier used for?
When to use Modifier 32. Modifier -32 indicates a service that is required by a third-party entity, Worker's Compensation, or some other official body. Modifier 32 is no used to report a second opinion request by a patient, a family member or another physician. This modifier is used only when a service is mandated.
What is modifier 29 used for?
What Is A 29 Modifier?: Global procedures, those procedures where one provider is responsible for both the professional and technical component. Note: Modifier 29 has been deleted. If a provider is billing for a global service, no modifier is necessary.
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.
What is ICD 10 code for speech therapy?
2. F80. 2 — Mixed receptive-expressive language disorder.
What is the CPT code for speech and language evaluation?
92506Currently, CPT code 92506 is billed for the evaluation of speech, language, voice, communication, and/or auditory processing.
What is GY modifier for Medicare?
GY - Item or service statutorily excluded or does not meet the definition of any Medicare benefit. GZ - Item or service expected to be denied as not reasonable and necessary.
What is GT modifier?
What is GT Modifier? GT is the modifier that is most commonly used for telehealth claims. Per the AMA, the modifier means “via interactive audio and video telecommunications systems.” You can append GT to any CPT code for services that were provided via telemedicine.
What is KX modifier?
The KX modifier, described in subsection D., is added to claim lines to indicate that the clinician attests that services at and above the therapy caps are medically necessary and justification is documented in the medical record.
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 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.
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 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.
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).
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.
Why is modifier -22 not used?
Modifier -22 shouldn't be used frequently because the Medicare contractor could determine 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 is modifier 59?
Modifier -59 is used to establish one procedure as distinct from another procedure billed on the same day, but should only be used based on instruction from the payer. Medicare publishes National Correct Coding Initiative (CC) edits that may require modifier -59.
How often are CPT codes billed?
Most CPT/HCPCS codes reported by audiologists 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 code only when face-to-face time spent in an evaluation is at least 51% of the time designated in the code's descriptor.
What is a CPT modifier?
CPT Modifiers are an important part of the managed care system or medical billing. A service or procedure that has both a professional and technical component. (26 or TC) A service or procedure that was performed more than once on the same day by the same physician or by a different physician. (76 or 77)
Why is CPT modifier important?
CPT Modifiers are also playing an important role to reduce the denials also. Using the correct modifier is to reduce the claims defect and increase the clean claim rate also. The updated list of modifiers for medical billing is mention below
What is a modifier 76?
Modifier 76- Repeat procedure or service by the same physician or other qualified healthcare professional. It may be necessary to indicate that procedure or service was repeated by the same physician or other qualified health professional subsequent to the original procedure or service.
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.
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.”
Do SLPs count toward the same threshold amount?
Because PT and SLP services count toward the same threshold amount, it’s absolutely critical that SLPs inquire about any physical therapy services a Medicare patient has received during the plan year before submitting claims for any SLP services.
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.
Spotlight
The Therapy Services webpage is being updated, in a new section on the landing page called “Implementation of the Bipartisan Budget Act of 2018”, to: (a) Reflect the KX modifier threshold amounts for CY 2021, (b) Add more information about implementing Section 53107 of the BBA of 2018, and (c) Note that the Beneficiary Fact Sheet has been updated.
Implementation of the Bipartisan Budget Act of 2018
This section was last revised in March 2021 to reflect the CY 2021 KX modifier thresholds. On February 9, 2018, the Bipartisan Budget Act of 2018 (BBA of 2018) (Public Law 115-123) was signed into law.
Other
On August 16, 2018, CMS issued a new Advance Beneficiary Notice of Noncoverage (ABN) Frequently Asked Questions (FAQ) document to reflect the changes of the Bipartisan Budget Act of 2018. Please find the document in the below Downloads section titled: “August 2018 ABN FAQs”.
What is a therapy code list?
As provided under Section 1834 (k) (5) of the Act, a therapy code list was created based on a uniform coding system (that is , the HCPCS) to identify and track these outpatient therapy services paid under the Medicare Physician Fee Schedule (MPFS).
Is CPT 92508 covered for dysphagia?
Group therapy coverage for dysphagia is covered using CPT 92508 and can be covered if the following criteria are met:#N#Rendered under an individualized plan of care;#N#Has less than five group members;#N#Does not represent the entire plan of treatment;#N#Requires the skills of a licensed therapist#N#Promotes independent swallowing
When do you need to submit KX modifier?
Providers of outpatient therapy services are required to submit the KX modifier on their therapy claims, when an exception to the cap is requested for medically necessary services.
What is the KX modifier?
A: The KX modifier is added to claim lines to indicate that the clinician attests that services are medically necessary and justification is documented in the medical record. Even though no special documentation is submitted to the contractor for automatic process exceptions, the clinician is responsible for consulting guidance in the Medicare manuals and in the professional literature to determine if the beneficiary qualifies for the automatic process exception. In addition, the clinician’s opinion is not binding on the Medicare contractor; the Medicare contractor makes the final determination concerning whether the claim is payable.#N#Q: When are exceptions to the therapy caps for services provided in a SNF setting considered?#N#Revised 09/2015
When exceptions are in effect and the beneficiary qualifies for a therapy cap exception, the provider shall add
When exceptions are in effect and the beneficiary qualifies for a therapy cap exception, the provider shall add a KX modifier to the therapy HCPCS code subject to the cap limits. The KX modifier shall not be added to any line of service that is not a medically necessary service; this applies to services that, according to a local coverage determination by the contractor, are not medically necessary services.
When did the KX modifier expire?
Section 202 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the therapy cap exceptions process through December 31, 2017. As a reminder, excessive use of the KX modifier including routine use of the modifier prior to reaching the cap limits may indicate abusive billing.
What is documentation justifying services?
A: Documentation justifying the services shall be submitted in response to any Additional Documentation Request (ADR) for claims that are selected for medical review. If medical records are requested for review, clinicians may include, at their discretion, a summary that specifically addresses the justification for therapy cap exception and they should follow the documentation requirements listed
When can a beneficiary use the cap exceptions process?
The beneficiary may qualify for use of the cap exceptions process at any time during the episode when documented medically necessary services exceed caps. All covered and medically necessary services qualify for exceptions to caps. All requests for exception are in the form of a KX modifier added to claim lines.
Can you use KX modifier on PT lines?
o Use the KX modifier on either all or none of the SLP lines on the claim, as appropriate. In contrast, if all the OT lines on the claim are below the cap, do not use the KX modifier on any of the OT lines, even when the KX modifier is appropriately used on all of the PT lines.
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 …
Designation of Time
Code Modifiers
- Clinicians use code modifiers appended to CPT or HCPCS codes on a claim to provide additional information about the services 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 p...
Same-Day Billing Restrictions
Laterality
Codes with The Professional and Technical Component (Pc/Tc) Split
Additional Resources
Cpt Codes and Special Medicare Rules For Audiologists