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Are you a speech-language pathologist or other medical professional specializing in speech therapy or the evaluation of speech? Are you just starting out with your own practice?
If so, is your practice fully up to date on current changes in speech therapy medical billing? If not, no worries!
Medical billing codes change all the time. Even expert coders and billers sometimes have difficulty seeking reimbursement from insurance carriers.
There are tons of CPT (current procedural terminology) codes to choose from, and many of them are quite similar. To run your practice efficiently, it is crucial to have a strong and thorough knowledge of medical codes for speech therapists.
Coding is complicated. We get it. That’s why we at Neolytix want to help up-and-coming practices get off on the right foot with speech therapy medical billing.
That’s what we’ll be discussing today.
Speech Therapy Medical Billing & Coding 2024 Updates
Starting January 1, 2024, A speech Therapist may begin to bill for Caregiver Training without the Patient Present. This service is a direct, skilled intervention for the caregiver to provide strategies and techniques to equip caregivers with knowledge and skills to assist patients living with functional deficits.
These new CPT codes represent the total duration of face-to-face time spent by the qualified healthcare professional providing training to the caregiver for an individual patient without the patient present. Caregiver training can also be performed in a group setting for multiple patients with similar conditions or therapeutic needs without the patient present.
Caregivers learn skills for intervention, how to use verbal instructions, video and live demonstrations, and feedback from the qualified healthcare professional on the use of strategies and techniques to facilitate functional performance and safety in the home or community without the patient present. These CPT codes are defined as:
CPT 97550 is defined as without patient present face-to-face caregiver training which provides strategies and techniques to facilitate the patient’s functional performance in the home or community (e.g., activities of daily living (ADLs), instrumental ADLs (IADLs) transfers, mobility, communication, swallowing, feeding, problem-solving, safety practices) initial 30 minutes.
97551 Caregiver training each additional 15 minutes (use with 97550 only).
97552 is defined as without patient present face-to-face multiple sets of caregivers training which provides strategies and techniques to facilitate the patient’s functional performance in the home or community (e.g., activities of daily living (ADLs), instrumental ADLs (IADLs) transfers, mobility, communication, swallowing, feeding, problem-solving, safety practices)
Let Us Review Speech Therapy Medical Billing & Coding in 2024
Here we present a medical billing and coding 101-guide for speech therapists and speech-language pathologists.
We will review the most used CPT codes, the differences between them, and the designation of time, modifiers, and proper documentation.
Choosing the correct CPT codes will ensure that your speech therapy practice always receives proper reimbursement for services provided. It will help you stay fully compliant with CMS guidelines and avoid costly, time-consuming rejections. The cleaner claims your practice submits on the first try, the more time you will have to practice speech therapy and provide care to patients who need it most.
| Speech, Language, Voice, and Cognition | |
|---|---|
| 92507 cpt code | Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual |
| 92520 cpt code | Laryngeal function studies |
| 92521 cpt code | Evaluation of speech fluency (e.g., stuttering, cluttering) (Can also be used for telemedicine/audio only) |
| 92522 cpt code | Evaluation of speech sound production (Can also be used for telemedicine/audio only) |
| 92523 cpt code | With 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) (Can also be used for telemedicine/audio only) |
| 92524 cpt code | Behavioral and qualitative analysis of voice and resonance (Can also be used for telemedicine/audio only) |
| 92526 cpt code | “Treatment of swallowing dysfunction and/or oral function for feeding.” (Can also be used for telemedicine) |
| 97129 cpt code | Therapeutic interventions that focus on cognitive function (e.g., attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (e.g., managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes |
| 97130 cpt code | Each additional 15 minutes of therapy, when appropriate |
| 97533 cpt code | Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands; each 15 minutes |
| 92606 cpt code | Therapeutic service(s) for the use of non speech generating device, including programming and modification |
| 92609 cpt code | Therapeutic service(s) for the use of speech generating device, including programming and modification |
| 31575 cpt code | Laryngoscopy; flexible; diagnostic |
| 31579 cpt code | Laryngoscopy; flexible or rigid telescopic, with stroboscopy |
| Swallowing Function | |
|---|---|
| 92610 cpt code | Evaluation of oral and pharyngeal swallowing function |
| 92611 cpt code | Motion fluoroscopic evaluation of swallowing function by cine or video recording |
| 92612 cpt code | Flexible endoscopic evaluation of swallowing by cine or video recording |
| Caregiver Training for Speech-Language Pathology Services | |
|---|---|
| 97550 cpt code | Caregiver training 1st 30 min |
| 97551 cpt code | Caregiver training each add 15 |
| 97552 cpt code | Group caregiver training |
Commonly Used CPT Codes for Speech-Language Therapy
The following list contains the most used CPT codes for speech therapy medical billing. This is not a comprehensive list of CPT codes. Rather, it is a general description of services that are commonly performed.
Each CPT code describes an individual medical, diagnostic, or surgical procedure or service. The AMA created each code to best reflect the service rendered by the provider. The medical coder’s job is to choose the code that best reflects the service rendered by the healthcare professional.
We will look at the requirements for performing these procedures as well as documenting them using the correct medical codes for speech therapists.
CPT Code 92507: Treatment of speech, language, voice, communication, and/or auditory processing disorder, Individual
The individual patient undergoes developmental programs under the direction of a physician. These include:
- Speech therapy
- Sign language
- Lip-reading instruction
- Hearing rehabilitation
The patient in these cases is typically a child who has problems processing information they hear. This is often due to a lack of integration between the ears and the brain. In the case of an auditory processing disorder, even though the patient’s hearing abilities may be normal, they may have difficulty understanding aural information.
CPT Code 92521: Evaluation of Speech Fluency
Let us go over CPT code 92521. This is one of the most important medical codes for speech therapists. It refers to the evaluation of speech fluency, specifically speech fluency disorders such as stuttering, cluttering, etc.
Be aware that anterior rhinoscopy, tuning fork testing, otoscopy, removal of non-impacted cerumen, and other diagnostic/treatment services not included in E/M service are bundled into CPT code 92521.
To choose this CPT code, the provider evaluates the patient’s fluency level with quantitative and qualitative assessments. They may take a measurement of speaking rate such as SPM (syllables per minute).
The provider then documents the severity, frequency, secondary characteristics, self-awareness/self-correction/perception, and types of disfluencies during the encounter with the patient.
CPT Code 92523: Speech Sound Production and Expressive Language
Finally, an example of how a CPT code must provide specific information in the medical record to choose the code for billing purposes is CPT code 92523.
This code refers to the evaluation of speech sound production. This may include articulation, phonological process, apraxia, or dysarthria. It also includes the evaluation of language comprehension and expression, namely receptive and expressive language.
Documentation must include:
- The ability to execute motor movements needed for speech
- Written comprehension and verbal expression
- A determination of the patient’s ability to create and communicate expressive thought
- An evaluation of the patient’s ability to produce speech sounds
- Lastly, the selection of the appropriate ICD-10-CM diagnosis code, which officially took effect October 1, 2023, until September 30, 2024.
The physician takes a patient history, including speech and language development, hearing loss, and physical and mental development, and performs a physical examination.
Speech and language evaluations are conducted. Assessment of any deficits is noted and a treatment plan for the patient is developed. This plan could involve speech therapy, hearing aids, etc.
Once again, medical documentation is key in selecting the correct CPT code for speech therapy medical billing.
Is the provider evaluating speech fluency or speech sound procedure? The general rule is that, if a service is not documented, it did not actually occur.
Hence, the providers must document everything properly and accurately to avoid incorrect billing and be paid on time.
Are you concerned about receiving and validating the necessary information on time? Check out these custom online fillable forms from Practice Tech Solutions!
Time Units in Speech Therapy Medical Billing
Some medical codes for speech therapists are time-based CPT codes following Medicare’s time units. The general notation for time-based CPT codes as found in the CPT book are:
- The first hour of a speech-generating device (SGD) evaluation
- Each additional 30 minutes of the SGD evaluation
- Aphasia evaluation, per hour
- The first hour of an aural rehabilitation evaluation
- Each additional 15 minutes of the aural rehabilitation evaluation
The chart below outlines the time units to be reported based on the time specified in the medical documentation. For CPT codes designated as 15 minutes, multiple coding represents the minimum face-to-face treatment for the CPT code to be reported.
| 1 unit | 8 minutes to < 23 minutes |
| 2 units | 23 minutes to < 38 minutes |
| 3 units | 38 minutes to < 53 minutes |
| 4 units | 53 minutes to < 68 minutes |
| 5 units | 68 minutes to < 83 minutes |
| 6 units | 83 minutes to < 98 minutes |
For example, consider the medical documentation from a therapy session with the patient. Suppose the healthcare professional documented that the time spent with the patient was 25 minutes of face-to-face time.
In this case, the number of units for that CPT code would be two. Why? Because the healthcare professional codes based on the timespan associated with given time units. Since, 25 minutes falls between 23 and 38 minutes, two units should be reported.
The key to billing CPT codes is to understand whether it is a time-based CPT code or an untimed CPT code. If there is no time designated in the official descriptor, the code represents a typical session and should only be reported as one unit.
Check out this post for more advice on medical billing for therapists.
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:
• 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.
• Modifier -22: when the physician believes the work required to provide a service is substantially greater than typically required. Documentation must support this substantial additional work and the reason for it.
• Modifier -52: when a service or procedure is partially reduced or eliminated at the physician’s discretion.
• Modifier -59: to identify procedures or services, other than E/M services, which are not normally reported together but are appropriate under the circumstances.
There are also restrictions on certain CPT code pairs billed on the same day. For these, the medical billers should refer to the National Correct Coding Initiative (CCI) edits.
The providers must also note that cognitive therapy by speech-language pathologists is covered in most Medicare Part B and commercial insurance.
There are additional billing guidelines and instances of medical necessity outlined in the CMS listings of Local Coverage Determinations (LCDs) and National Coverage Determinations (NCDs).
For more information, consult the Medicare Benefit Policy Manual.
Records Documentation Requirements for Speech Therapy Medical Billing
Documentation plays a crucial role in explaining the medical necessity of the procedures rendered by the provider. All documentation must comply with legal/regulatory requirements applicable to the state in which the provider practices. All medical records must show medical necessity, including the appropriate type, frequency, intensity, and duration regarding the individual needs of the patient. In addition, all medical records should include:
• Initial Evaluation: plan of care; documentation for medical necessity; objective findings.
• Plan of Care: diagnoses; long term treatment goals; type, amount, duration, and frequency of therapy services.
• Progress Reports: continued assessment or treatment; short- and long-term goals.
• Treatment Notes: the encounter notes must record the name of the treatment, intervention of activity provided, total treatment time, and signature of the professional furnishing the services.
If you are still a little unsure about documentation or just do not have time to do it yourself, consider hiring a virtual medical assistant. Medical VAs can manage all kinds of administrative tasks with expertise and efficiency.
Most Common Reasons for Speech Therapy Claim Denials
1. Medical necessity has not been met for billing speech therapy: If medical necessity is not met, the insurance company will deny the claim. All services rendered must be met by medical necessity and have the appropriate ICD-10-CM diagnosis code. If the diagnosis code cannot show the likelihood of the condition or injury, the insurance company will not consider the service appropriate.
2. Incorrect modifiers: Modifiers must be entered correctly on the claim, or the insurance companies will deny the service. Practice managers must make sure that the patient did not reach their cap for the services.
3. Incorrect CPT codes: CPT codes change rapidly, so the practice should keep their superbills updated to the most accurate CPT codes set by AMA.
4. Inaccurate use of time-based codes: This is another common mistake. If a CPT code is time-based, make sure the units of service are accurate.
5. Timely filing: Make sure all claims are submitted on time without any issues.
Fast-track Your Speech Therapy Coding and Billing Efficiency
So! We have covered a lot of information on medical codes for speech therapists in a short amount of time. Thank you for reading all the way to the end!
We hope this blog shows the importance of medical records and how they play a key role in revenue cycle management. Providers must comply with medical documentation, fully explain the medical need for services rendered, and submit clean claims to the insurance companies.
If the documentation is clear and well written, the billing is a piece of cake. Make a habit of staying up to date on the latest changes and it will save you a lot of trouble further on up the road.
Want some help with your medical billing? Neolytix offers a full selection of medical billing services, as well as a comprehensive FAQ section below. We are happy to help with all your speech therapy billing and coding needs.
Call us anytime or complete the form below for a free consultation.
FAQs - Everything You Need to Know About Speech Therapy Billing and Coding
The CPT codes for speech therapy are essential for accurate billing and reimbursement. Commonly used speech therapy procedure codes include:
- 92507 CPT code: Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual.
- 92523 CPT code: Evaluation of speech sound production and language comprehension/expression.
- CPT 92521: Evaluation of speech fluency, such as stuttering or cluttering.
Accurate coding ensures proper reimbursement for services rendered and compliance with CMS guidelines.
Billing for group speech therapy involves using specific CPT codes that reflect the nature of the group setting. For instance, CPT 97550 and 97552 are used for caregiver training without the patient present, which can include group settings. Proper documentation of the session's duration and the specific activities conducted is crucial.
The ICD-10 code for speech therapy PCS (Procedure Coding System) typically depends on the specific condition being treated. For instance, R47.89 is used for other speech disturbances. Detailed documentation of the patient's condition and treatment plan is necessary for accurate coding.
The CPT code for talk therapy, often referred to as psychotherapy, is 90834 for a standard 45-minute session. This is different from speech therapy CPT codes, which are more focused on treating speech and language disorders.
In speech language pathology, accurate documentation and reimbursement are facilitated by several SLP billing codes. Commonly utilized CPT codes include:
- 92507: Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual.
- 92523: Evaluation of speech sound production with evaluation of language comprehension and expression. The 92523 CPT code description specifically addresses the assessment of both articulation ability and language comprehension skills, which is essential for detailed patient evaluations.
These codes, including the critical CPT code for speech therapy, ensure precise documentation and facilitate appropriate reimbursement.
Modifiers significantly enhance the specificity of speech therapy billing, ensuring clarity and compliance with insurer requirements. Common speech therapy modifiers include:
- GN: Indicates services delivered under an outpatient speech language pathology plan of care, which is pivotal when using specific speech therapy CPT codes like 92523.
- GO: Denotes services delivered under an outpatient occupational therapy plan of care.
These modifiers, when used with speech therapy CPT codes, particularly the 92523 CPT code, clarify the service setting or specialization, thereby ensuring accurate billing and optimal reimbursement practices.
The GN modifier is used to indicate that speech therapy services are provided under a Medicare plan of care for speech-language pathology. This modifier ensures that the services are appropriately billed under the correct plan.
Yes, a speech therapist can bill 97129, which is for therapeutic interventions focusing on cognitive function and compensatory strategies. Each additional 15 minutes of therapy can be billed using 97130.
The ICD-10 code for a general speech problem is R47.89, which covers other speech disturbances. This can be used for conditions not specifically categorized under other codes.
Yes, some speech therapy codes are time-based. For example, CPT 97129 and 97130 are time-based codes requiring documentation of the duration of the session. Understanding whether a code is time-based is crucial for accurate billing.
The 8-minute rule in speech therapy is used to determine how many units of a time-based CPT code can be billed. If a service is provided for at least 8 minutes but less than 23 minutes, one unit can be billed. This rule ensures precise billing for the time spent on therapy.
The billing code 90847 is used for family or couples therapy, where the patient is present, and it typically involves therapeutic intervention. This is distinct from speech therapy CPT codes but is important for comprehensive therapeutic services.
The ICD-10 code for a speech fluency disorder, such as stuttering, is F80.81. Accurate diagnosis coding ensures that the treatment and billing align with the patient's condition.
Neolytix is a leading pathology billing and coding company dedicated to providing expert services in medical billing and coding. Our goal is to help practices navigate complex billing scenarios, from the 92507 CPT code description to handling various speech therapy modifiers. Whether you're managing billing speech therapy services or need assistance with speech therapy evaluation documentation, Neolytix is here to support your practice every step of the way.
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