IMPORTANT!

The new CPT codes for speech/language evaluations (92521, 92522, 92523, and 92524) will NOT be in the NCTracks system by January 1, 2014. There will be a Medicaid Bulletin article stating the date to begin using these codes!

As of January 1, 2014, Current Procedural Terminology (CPT, ©American Medical Association) code 92506 (Evaluation of speech, language, voice, communication, and/or auditory processing) will no longer be used and will be replaced with four new, more specific evaluation codes related to language, speech sound production, voice and resonance, and fluency disorders.

Currently, CPT code 92506 is billed for the evaluation of speech, language, voice, communication, and/or auditory processing. This code is considered an “umbrella” code and will be replaced with four new, more specific evaluation codes related to language, speech sound production, voice and resonance, and fluency disorders.

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:

  • 92521 Evaluation of speech fluency (e.g., stuttering, cluttering)
  • 92522 Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)
  • 92523 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)
  • 92524 Behavioral and qualitative analysis of voice and resonance

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

Why are four new codes replacing CPT 92506?

The four new evaluation codes were developed by ASHA’s Health Care Economics Committee (HCEC) in collaboration with experts in the field from ASHA’s Special Interest Groups. The HCEC has been working with the American Medical Association (AMA) to change most speech-language pathology codes since 2009, when a new law took effect that allows private practice SLPs to bill Medicare directly for their services. Because of that change, the AMA’s Relative Value Update Committee re-evaluated speech-language pathology codes to include “professional work” value (one of three components of a code’s value that reflects the amount of time, technical skill, physical effort, stress, and judgment required to provide the service). Prior to 2009, SLPs were considered “technical support” and their work was included in the “practice expense” component of the code’s reimbursement formula. During this process, the RUC recognized that CPT 92506 reflected more than one procedure; this recognition gave ASHA an opportunity to develop specific evaluation procedure codes to replace 92506 and more accurately and appropriately value the professional work performed.

Unlike practice expense, professional work values do not change over time, allowing reimbursement rates for speech-language pathology codes to remain relatively stable.

When should I start using the new codes?

You should use the new codes for billing patients and filing health insurance claims for services provided on or after January 1, 2014. Continue to use 2013 evaluation codes for services provided before January 1, 2014, even if the bill is submitted in the New Year.

How will reimbursement rates compare to 92506?

Because CPT 92506 included many different evaluation procedures, SLPs have been paid the same rate whether they provided an evaluation for one disorder or many. The new codes essentially reflect smaller components of the original 92506, so SLPs should expect to see lower payments for each type of evaluation when compared with past payments for 92506.

What is the reimbursement rate for each code?

The Centers for Medicare and Medicaid Services (CMS) typically announces new payment rates in November as part of the Medicare Physician Fee Schedule (MPFS). Other third-party payers generally publish new payment rates after the release of the MPFS. You should contact your payer directly for their 2014 fee schedules.

ASHA will publish the Medicare 2014 national rates for speech-language pathology codes after the MPFS is released.

Are the new 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’sbilling and reimbursement webpage.

Can the new 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.

Medicare Part B instructs SLPs to use CPT 92506 to bill for a non-speech generating device evaluation. What should I do now that 92506 is deleted?

In anticipation of the deletion of 92506, ASHA submitted a letter to the Centers for Medicare and Medicaid Services (CMS) requesting that CPT 92605 (Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour) and CPT 92618 (each additional 30 minutes) be added to the Medicare Physician Fee Schedule (MPFS). We will not know whether this recommendation was accepted until CMS publishes the 2014 MPFS in November.Who should I contact if I have problems billing the new codes?

You should start by getting in touch with your payer to ensure they are aware of the coding change. Sometimes, coding systems are not completely updated by the first of the year, causing billing problems.

For Medicare, get in touch with the Medicare Administrative Contractor in your area.

If you continue to have problems, please contact ASHA’s health care economics and advocacy team at[email protected].

Where can I find more information about the new codes?

ASHA will continue to post all new information on our website. Please check back often. Notifications and news items will also be available through ASHA Headlines and The ASHA Leader.

Specific questions can be directed to ASHA’s health care economics and advocacy team at [email protected].