The CPT codes for speech/language evaluations (92521, 92522, 92523, and 92524) have been in use since January 2014.

CPT guidelines do not include language to restrict your ability to bill these codes together because there are circumstances when it is appropriate for a patient to be evaluated for multiple disorders on the same day. In these cases, it is highly recommended that documentation clearly reflect a complete and distinct evaluation for each disorder. Evaluation codes should not be billed for brief assessments that could be considered screenings.

Additionally, the Corrective Coding Initiatives (CCI edits) has updated Speech Therapy 92507 and Cognitive Skills Development 97532 cannot be billed on the same day by speech therapy. Code 92507 is considered an inclusive code, including cognitive linguistic training as well. It can however be billed by different disciplines on the same day, for example, OT billing Cognition and ST billing speech.

The new codes are:

Additional evaluation codes available:

  • *96105 Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour
  • *96125 Standardized cognitive performance testing (eg, Ross Information Processing Assessment) 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

 

Are these codes appropriate for services provided to adults and children?

Yes, SLPs may use these codes for any patient population, as long as they are the codes that are most descriptive of the evaluation being provided. Keep in mind that other evaluation codes—for dysphagia, aphasia, and cognitive performance, among others—are also available for the adult population. A full list of CPT codes available to SLPs can be found on ASHA’s billing and reimbursement webpage.

Can these codes be billed together on the same day or with other existing codes?

The CPT Handbook does not include language to restrict an SLP’s ability to bill these codes together because there are circumstances when it is appropriate for a patient to be evaluated for multiple disorders on the same day. In those cases, documentation should clearly reflect a complete and distinct evaluation for each disorder. Evaluation codes should not be billed for brief assessments that could be considered screenings. Time for identification of other disorders is already built into the value of each code; inappropriate use of multiple evaluations on the same day could result in restrictions through the National Correct Coding Initiative (CCI) edits. CCI edits control specific code pairs that can or cannot be billed on the same day for Medicare and Medicaid services; CCI edits are also followed by many other third-party payers.

While no restrictions appear in the CPT Handbook, the 2014 quarterly CCI edits have not yet been published. ASHA will closely monitor the CCI edits and inform members of any restrictions on same-day billing, should they arise. All new or updated edits will be posted on ASHA’s CCI edits webpage when they become available.

Why is 92523 a combined speech sound production and language evaluation? What if I perform only a language evaluation?

If two or more procedures are billed together at least 51% of the time, it is standard to develop a bundled CPT code for that set of services. During the code development process, ASHA surveyed practices and clinics and confirmed that a child evaluated for language is also evaluated for speech sound production ability more than 80% of the time. However, the reverse is not true. It is common practice for a child to be evaluated for speech sound production ability independent of a language evaluation, which is why there is a stand-alone code for speech sound production evaluation.

If a patient is evaluated only for language, SLPs should bill 92523 with the -52 modifier, which is used when the services provided are reduced in comparison with the full description of the service. Keep in mind that there is also an aphasia assessment code (CPT 96105) that may be appropriate for some adults.

Can I bill 92522 and 92523 together on the same day?

No, you may only bill one or the other. A speech sound production evaluation (CPT 92522) is already included as a part of CPT 92523 (speech sound production evaluation with language evaluation).

How should I bill for a cognitive evaluation?

ASHA recommends billing CPT 96125 (Standardized cognitive performance testing, per hour) for a full cognitive evaluation. If you also perform an extensive speech/language assessment, use CPT 92523.