Speech Therapy Billing: Questions and Answers
It has been awhile since I have written an article focused on outpatient speech therapy and billing. So this week, I thought I would provide answers to some of the more common questions I receive about billing for speech therapy services. The answers I provide are based on what the Medicare Part B program allows and these answers may or may not be applicable to Medicare Advantage plans, Medicaid, managed Medicaid plans, private/commercial insurance carriers, workers compensation and automobile carriers.
Here are the questions I will answer in this article:
- Can you be paid for CPT codes 92507 and 92526 on the same date of service to the same patient?
- Can you be paid for an evaluation of oral and pharyngeal swallowing function and a modified barium swallow study on the same date of service to the same patient?
- Does the Medicare program pay for treatment on the same date of service you bill any type of evaluation CPT code?
- How many evaluations described by different CPT codes will the Medicare program pay for on either the same date of service or during the same episode of care?
- What is CPT code 96105 and does the Medicare program pay for that CPT code?
- What is CPT code 96125 and does the Medicare program pay for that CPT code?
- Do you always need to have an evaluation for what you are treating? For example, if I do a swallow evaluation, but I noticed speech issues, do I need to then evaluate speech before I can treat or can I just go straight to speech treatment even though I only evaluated swallowing?
- Can speech-language pathologists bill CPT codes 92507 or 92508 on the same date of service as CPT codes 97127, 97533 or HCPCS Level II code G0515?
- Can speech-language pathologists bill CPT codes 97110, 97112, 97150, 97530 or HCPCS Level II code G0515?
Lets begin!
Question
Can you be paid for CPT codes 92507 and 92526 on the same date of service to the same patient?
Answer The content here is for members only log in here or sign up. Question Can you be paid for an evaluation of oral and pharyngeal swallowing function and a modified barium swallow study on the same date of service to the same patient? Answer The content here is for members only log in here or sign up. Question Does the Medicare program pay for treatment on the same date of service you bill any type of evaluation CPT code? Answer The content here is for members only log in here or sign up. Question How many evaluations described by different CPT codes will the Medicare program pay for on either the same date of service or during the same episode of care? Answer The content here is for members only log in here or sign up. Question What is CPT code 96105 and does the Medicare program pay for that CPT code? Answer The content here is for members only log in here or sign up. Question What is CPT code 96125 and does the Medicare program pay for that CPT code? Answer The content here is for members only log in here or sign up. Question Do you always need to have an evaluation for what you are treating? For example, if I do a swallow evaluation, but I noticed speech issues, do I need to then evaluate speech before I can treat or can I just go straight to speech treatment even though I only evaluated swallowing? Answer The content here is for members only log in here or sign up. Question Can speech-language pathologists bill CPT codes 92507 or 92508 on the same date of service as CPT codes 97127, 97533 or HCPCS Level II code G0515? Answer The content here is for members only log in here or sign up. Question Can speech-language pathologists bill CPT codes 97110, 97112, 97150, 97530 or HCPCS Level II code G0515? Answer The content here is for members only log in here or sign up. I hope you enjoyed this article and that it answered some of the questions you had about CPT codes commonly used by speech-language pathologists as well as speech therapy billing. If you have additional questions, please email them to info@gawendaseminars.com and I will answer them in a future article. Thank you for being a Gold Member!
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Question: When SLP work with Radiologists for barium swallow studies there is the new ruling that prevents billing 74230 from the radiologist and 92611 from the SLP. As recently as last year, these two codes were recommended by ASAH. In fact, that information is still up on their website. Starting in 2020 it looks like 74230 and 92611 cannot be billed together, even with a modifier.
Do you have any information on how these should be coded by the radiologist and SLP? We have speculated that the radiologists should bill 74220 and SLP continue with 92611.
Any help or direction is greatly appreciated!
If you require consulting services in this area, please email me at info@gawendaseminars.com and I can tell you what I would need from you for a contract proposal.
We will definitely consider. For now, it looks like ASHA released a statement yesterday, clarifying the issue and their recommended course of action.
What ASHA did not say and/or did not consider is that 92611 and 74230 are not usually billed on the same claim form under the same NPI number. The radiologist usually bills for their services on a 1500 claim form under their NPI number.
in an ASHA article on billing it reads that eval codes cannot be billed more than once per day.
Also, can the same eval code be used more than once if for example, the full evaluation takes more than one treatment session to complete?
Can I bill an untimed code more than once per day?
Medicare specifies that evaluation or assessment procedures may be billed only once per discipline, per date of service, per patient (CPT 92521, 92522, 92523, 92524, 92597, 92607, 92611, 92612, 92616). Additionally, treatment codes may be subject to Medicare’s Medically Unlikely Edits (MUEs), which specify how many times a code may be billed per date of service. For instance, the MUE for CPT 92507 prevents this code from being billed more than once in a day. Many payers will adopt Medicare policy.
All untimed codes can only be billed once per day, regardless of the amount of time to perform.
If a child has feeding difficulties and the SLP determines in the evaluation that the feeding difficulty is aversion (ie.aversion to texture, limited diet due to strong preferences, etc..) and there is NOT an oral or pharyngeal/swallowing problem, what is the appropriate treatment code for aversion feeding therapy? Is it 97533? 92526? Just want to bill correctly thanks!
Due to liability reasons, I can’t tell you which code to bill. You would need to make that determination based on interventions provided and documentation in the medical record. You could also reach out to ASHA to see if they will provide you with any guidance.
How about I rephrase…. does 92526 ONLY cover feeding issues that have a dysphagia component or does 92526 cover sensory/texture issues? I’m really trying to determine what components 92526 covers. In a few articles I have read it does state 92526 covers “Oral sensitivity training” but does that mean? oral defensiveness?
I would recommend you contact your professional association, ASHA.
If a patient (i.e. Parkinson’s) is referred for eval and treat of speech disorders, can/should you bill both the speech and swallow eval code on the same day if you determine they also have a swallowing disfunction?
If you only bill one (i.e. speech eval) then can you provide swallowing treatment without performing the evaluation?
If you performed a speech and language evaluation and a swallow evaluation on the same day, you should bill both. Medicare pays for both on same day. You would need to check with your other insurance carriers.