Billing CPT Code 92507 on Same Day as CPT Code 97127

January 22, 2018
Rick Gawenda

A question I receive is can a speech-language pathologist (SLP) bill CPT code 92507 (treatment of speech, language, voice, communication, and/or auditory processing disorder, individual) or CPT code 92508 (treatment of speech, language, voice, communication, and/or auditory processing disorder, group) on the same day they also bill CPT code 97127 – therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact? To simplify the question, can an SLP bill 92507 and/or 92508 and 97127 on the same day for a patient who has Medicare as their insurance? The answer might surprise you!

According to the National Correct Coding Initiative (NCCI)

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  1. I have some doubts about billing and coding. We have seen the CCI Edits but still have some questions. Can we make combinations for the following CPT codes on the same date of service and for the same SLP?

    – 97533 by itself
    – 92526 with 97533
    – 97127 with 97533
    – 92526 with 97533 and 97127

    Looking forward for your response!

    1. Please read the article as the article states what can’t be billed the same day by the same SLP.

    2. Thank you for your response but we have been searching and reading all your articles and in non of them they state the correct billing procedure for the combinations asked. In this article specifically it only mention about the 92507 with 97127, we have that clear. If any other support documentation that we can used to clarify our doubts please let us know. Thanks again!

      1. You would need to read the NCCI Policy Manual, check the CMS CCI edits and check with all other insurance carriers on what is and is not allowed to be billed on the same day by the same SLP.

  2. 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.

    1. The same discipline can bill both those codes the same visit as long as documentation supports both. You would then need to check with each insurance carrier to see if they pay for both provided on the same day of services and if yes, is modifier 59 required.

    1. In the inpatient rehab setting, you do not bill via CPT codes. You need to provide 3 hours of therapy 5 out of 7 days.

  3. Can the SLP add the modifier 59 to indicate that they are providing 2 separate and distinct services performed at different times during the treatment session if their documentation supports.
    I.E. Patient who has a stroke with Aphasia treated 30 minutes on word finding exercise to assist with patient speech and language issues (92507) and in the last 30 minutes of the session the SLP would work on memory problem solving issues for cognitive deficits (97127)

  4. Hi Rick,
    The passage below is from MM10303. As it stands right now, would it be accurate to say that 97127 would continue to be used for non-Medicare insurances? Thanks, Rick.

    “The panel also created, for CY 2018, CPT code 97127 to replace/delete CPT code
    97532. CMS will recognize HCPCS code G0515, instead of CPT code 97127, and add
    HCPCS code G0515 to the therapy code list. CPT code 97127 will be assigned a
    Medicare Physician Fee Schedule (MPFS) payment status indicator of “I” to indicate that
    it is “invalid” for Medicare purposes and that another code is used for reporting and
    payment for these services.”

    1. You would have to check with each insurance carrier to see if they will pay for CPT code 97127 or HCPCS Level II code G0515.

  5. Please clarify SLP billing both 92507 and G5015 on same date of service. The updated CCI Edit list on this website shows 92507 as column 1, and G0515 in column 2 with Yes for modifier allowed. However, the ASHA CCI chart states that the modifier is not allowed when an SLP provides both 92507 and G0515 on same date of service. Thank you, Deborah Price

    1. This is because SLP would bill 92507 but perhaps OT would bill G0515 on the same date of service. In a non-private practice setting, this is all billed on one claim form under the facilities NPI number and the need for modifier 59 would cross all disciplines in this setting.

  6. Please clarify the use of modifier 96 and 97 for use with CPT 92507?
    We are a clinic and bill with 92507-GN. Our claims are being denied

  7. Which code is more appropriate to bill (92507 or 97129) when a SLP provides treatment in the same session for communication, cognition, problem solving and executive functioning?

  8. Can SLP bill 92507 on the same day with 97530 and 97535 with the mod 59? We keep receiving denials for these. but the 59 modifier should make it payable, correct?

    1. Answer is yes, but it depends on which insurance carrier and if they are allowing the use of Modifier 59.