What does 92507 mean?
92507. Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual. Includes training & modification of voice prosthetics. (Reference: Federal Register, December 31, 2002, p. 80016.) SLPs may also use 92507 to report auditory (aural) rehabilitation. 92508
Is CPT code 92507 a timed code?
Most speech-language pathology codes do not have time units assigned to them, such as 92507 (speech-language treatment). If no time is noted in the descriptor, each code counts as one session. A complete list of the CPT codes for speech-language pathology services is available in the ASHA Medicare Fee Schedule or the ASHA Model Superbill for Speech-Language Pathology Practice [DOC].
What is the CPT code for speech therapy evaluation?
Common CPT Codes for Speech Therapy 92521 — Evaluation of speech fluency 92523 — Evaluation of speech sound production with evaluation of language comprehension and expression 92524 — Behavioral and qualitative analysis of voice and resonance 92507 — Treatment of speech, language, voice
What is the modifier for speech therapy?
What you need to know
- Appropriate Use: When additional documentation supports the medical requirements of the service under a valid medical policy.
- Inappropriate Use: When the claim provides all information on the service billed and medical documentation does not provide further explanation.
- Physical/Speech/Occupational Therapy. ...
What does CPT code 92507 mean?
or auditory processing disorder92507. Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual. Includes training & modification of voice prosthetics.
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.
What CPT codes are time-based?
The “Time” component is per patient and not per provider. This means if two providers spent 15 minutes together with the patient, only 15 minutes can be reported, not 30 minutes (15 minutes each)....Time.CPT CodeTotal Time9921320-29 mins9921430-39 mins9921540-54 mins6 more rows
Does CPT code 92507 need a modifier?
The eligible providers for service CPT 92507 are physical and occupational therapists, non-physician practitioners (NPPs), and Physicians in private practice. The provider must have append modifier GN if performing service (CPT 92507) personally for an outpatient setting.
Can you Bill 92507 twice a day?
Codes 92506, 92507 and 92508 are not considered time-based codes and should be reported only one time per session; in other words, the codes are reported without regard to the length of time spent with the patient performing the service. these CPT codes.
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".
How do you bill for time?
This can be done in various ways. One way is to simply say, “Visit time 30 minutes, counseling time 20 minutes.” Some physicians alternately use a statement that says, “This was a 30-minute visit, with greater than 50 percent counseling.”
What are prolonged services?
DEFINITIONS. Prolonged Services – (codes 99354, 99355, 99356 and 99357) are used when a physician provides prolonged service involving direct (face-to-face) patient contact that is beyond the usual services in either the inpatient or outpatient setting.
How do you document time?
You still must spend more than 50 percent of your time on counseling or coordination. To properly document your time, use statements like these: “I spent 30 minutes face-to-face with the patient, over half in discussion of the diagnosis and the importance of compliance with the treatment plan.”
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 92610 a timed code?
Here is a scenario to consider: a health plan sends you a notice saying it will no longer accept time units for untimed CPT codes, such as 92507 or 92610. The health plan offers a revised reimbursement rate that is significantly lower than the previous payment when time units were allowed.
Is CPT code 92526 A timed code?
In accordance with coding guidance from the American Speech-Language-Hearing Association (ASHA), CPT codes 92507 (Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual) and 92526 (Treatment of swallowing dysfunction and/or oral function for feeding) have no time ...
What would happen if the treatment code (92507) was revised?
If the treatment code (92507) is revised, the development of additional treatment codes that could address complexity of services would be considered at that time . ASHA would have to present evidence that the services are different in terms of the time it takes to perform the service, the level of technical skill, the physical effort, ...
How many times can you bill Medicare for CPT 92521?
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.
What is a CPT modifier?
One of the CPT modifiers is -22, added at the end of the CPT code. This modifier denotes a session or procedure that is unusually long. Many payers will increase reimbursement by 25 to 50 percent when this modifier is included, but the claim will be stopped for manual review and you will need to submit additional documentation with your claim to justify the increased services. Be warned that if you submit claims with the -22 modifier too often, the payer may conclude that the long sessions are not "unusual," and cease to honor the modifier.
How long is a 15 minute code?
No. Medicare has established specific minimum and maximum times for 15-minute codes and most payers have adopted this policy. The minimum time for one 15-minute code is 8 minutes. Two units would be a minimum of 15 + 8 minutes = 23 minutes. This rule is extended to multiple units in the following CMS table:
How long is a physical medicine code?
Historically, the physical medicine and rehabilitation procedure codes were assigned time units of 15 minutes while the codes for speech-language pathology were not. Because of the way codes are developed and established, it is difficult to revise descriptors without significant impact to reimbursement.
Can speech language pathology codes be billed by time units?
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). If no time is noted in the descriptor, each code counts as one session.
Is there a minimum time for untimed codes?
However, there are no hard and fast rules regarding time "minimums" for untimed codes. Ultimately, the decision to bill a code depends on the clinician’s judgement and documentation to support that the time spent with the patient was medically necessary and clinically appropriate for that patient on that day.
How can I tell an untimed code from a timed code?
Timed CPT codes always have a distinct unit of time listed in their descriptors. For example, CPT 92620 (Evaluation of central auditory function, with report; initial 60 minutes) is reported for the first hour of the evaluation, and CPT 92621 (Evaluation of central auditory function, with report; each additional 15 minutes) can be reported multiple times if the evaluation lasts for more than an hour.
What is a timed code for a cognitive test?
Other examples of timed codes include G0515 (Development of cognitive skills to improve attention, memory, problem-solving, direct [one-on-one] patient contact, each 15 minutes) and 96125 (Standardized cognitive performance testing, per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report). Codes that include “per hour” or “each 15 minutes” are billed multiple times per claim to reflect the total evaluation or treatment time.
How do I appropriately report timed codes?
You can report a timed code if you have spent at least half of the code’s specified time with the patient. The “American Medical Association CPT 2018 Professional Edition” indicates that “A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and 60 minutes). A second hour is attained when a total of 91 minutes have elapsed.”
Do these underlying times mean I must follow the 51-percent rule to report untimed codes?
No. There are no rules regarding the length of billed session-based codes. However, these underlying times can serve as a guide or advocacy tool when a clinician is feeling pressure to shorten session lengths to maximize time and payment.
Why are untimed codes important?
Untimed codes, therefore, allow a certain amount of flexibility—within reason—to spend more time with some patients and less with others. Underlying times may also help clinicians determine if they should bill a CPT code when a session is substantially shorter than the underlying time.
How long is a CPT code?
For example, a given CPT code has an underlying time of 60 minutes, which would be considered “typical” based on clinicians who regularly provide the service. However, a clinician could determine that 30–45 minutes may be appropriate for one patient, and 90 minutes may be appropriate for another. Untimed codes, therefore, allow a certain amount of flexibility—within reason—to spend more time with some patients and less with others.
What is CPT time?
The time associated with each CPT code includes pre-service time (before you see the patient), intra-service time (one-to-one evaluation or treatment with the patient), and post-service time (after the evaluation or treatment service has been completed). Pre- and post-service times generally include time spent reviewing records, preparing for the session, discussion of results with the patient and family/caregivers, report writing, and communicating with other health care providers. Because these activities are included in the value of each code, they generally cannot be billed separately with additional codes.
How often can you report CPT 92609?
CPT 92609 is an untimed code, meaning that it can be reported only once per day, regardless of the length of the session.
Is 92508 a timed code?
Furthermore, is 92508 a timed code? Codes 92507 and 92508 are not considered time-based codes and should be reported only one time per session; in other words, the codes are reported without regard to the length of time spent with the patient performing the service.
Is CPT 97127 untimed?
As a result, in 2018 both CPT 97127 (untimed) and G0515 (timed) existed causing misunderstanding for patients, providers, and payers. 97129, however, differs from the 97127, which was an untimed code, as 97129 is a timed code, direct (one-on-one) patient contact code; for an initial 15 minutes.
When was CPT code 92521 deleted?
Deleted in 2014. See CPT codes 92521-92524.
What modifier is used for 92523?
For evaluation of language only, apply a modifier -52. Don't bill 92523 in conjunction with 92522.
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.
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.
Does 92524 include instrumental assessment?
92524 doesn't include instrumental assessment of voice and resonance. For instrumental assessments, see 31579, 92511, and 92520.
Can speech pathologists report 97112?
CMS staff have concluded that speech-language pathologists should not report physical medicine codes 97110 (Therapeutic exercises, each 15 minutes) and 97112 (Neuromuscular reeducation, each 15 minutes). 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
