SKILLED SPEECH LANGUAGE PATHOLOGY SERVICES:
Nevada Medicaid may pay for the services of a licensed speech pathologist to provide service as ordered by the physician and identified in a signed POC. Reimbursement is based upon diagnosis and treatment of speech and language disorders that result in communications disabilities and for the diagnosis and treatment of swallowing disorders, regardless of the presence of a communication disability. There must be an expectation that the condition will improve in a reasonable period of time.
New CPT Evaluation and Assessment Codes for SLPs
As of January 1, 2014, Current Procedural Terminology (CPT, ©American Medical Association) code 92506 (Evaluation of speech, language, voice, communication, and/or auditory processing) has been deleted and replaced with four new, more specific evaluation codes related to the assessment of language, speech sound production, voice and resonance, and fluency disorders.
The old code is 92506–The new assessment codes are:
92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)
92523 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 Behavioral and qualitative analysis of voice and resonance
The rate structure for these codes for EarlySteps is different from the old rate for 92506 and is explained below,
In EarlySteps, the 92506 code was used for single-domain assessments, eligibility and exit evaluations and autism screenings. Since the code was discontinued, the replacement codes for
evaluations and screenings are:
• 96110 Eligibility and Exit (Outcome Measures) evaluations
• 96111 Autism screenings
COVERAGE AND LIMITATIONS:
Skilled speech language therapy service may be authorized for home care recipients. HHA visits are included in the total outpatient limits up to 24 visits per year. These include visits for the following:
- Diagnosis and treatment of expressive and receptive communication disorders;
- Diagnosis and treatment of swallowing disorders;
- Assessment of a recipient’s rehabilitation needs and potential;
- Services directed toward specific speech or voice production if a deficit exists resulting from an illness or an injury; Establishment of a hierarchy of speech-voice-language
communication tasks and cueing that is directed toward the achievement of specific communication goals; - Training the recipient/family/caregiver to augment: the speech language communication; treatment; or to establish a maintenance program;
- Assisting persons who are aphasic in rehabilitation of speech and language skills; and
- Assisting a person with voice disorders to learn to control vocal or respiratory systems for correct voice production.
Billing Guidelines
CPT code 92507 is used for the treatment of speech, language, voice, communication, and/or auditory processing disorder treatment. Treatment under this code can also include development of cognitive skills to improve attention and memory. Example of documentation:
92507: Therapist trained patient to use compensatory strategies to supplement orientation including calendar, clock, newspaper, and note pad to increase ability to self-orient and decrease confusion/agitation. Patient was able to orient x4 with Min A when utilizing compensatory strategies. Therapist challenged patient’s short-term memory by instructing patient to recall 4 words after a 5 minute delay. Patient was able to name 2/4 word after delay independently increasing to 4/4 words after repetition of trial. Therapist instructed patient to answer personal biographical information questions to improve long term memory. Patient was able to answer 8/10 questions correctly.
CPT code 97129 is used when billing for “therapeutic interventions that focus on cognitive function (e.g. attention, memory, reasoning, executive function, problem solving and/or pragmatic function) and compensatory strategies to manage the performance of an activity (e.g. managing time or schedules, initiating, organizing and sequencing tasks.” Billed for the initial 15 minutes of treatment provided.
CPT code 97130 is used when billing for “therapeutic interventions that focus on cognitive function (e.g. attention, memory, reasoning, executive function, problem solving and/or pragmatic function) and compensatory strategies to manage the performance of an activity (e.g. managing time or schedules, initiating, organizing and sequencing tasks.” Billed for each additional 15 minutes of treatment provided.
When billing both 97129 and 97130, the therapist has a choice in documenting the services provided. If the therapist has included a full description of all the skilled interventions and activities provided during the entirety of the treatment session under the initial code 97129 the treatment code of 97130 can be minimal. Otherwise, the therapist can include the specific activities during the first 15 minutes under 97129 and the remaining treatment activities under 97130.
