November 1, 2013 Departments

Policy Analysis: Four Billing Codes to Replace Speech-Language Evaluation Code

Four new billing codes that are specific for speech-sound production, language, fluency, and voice and resonance evaluations will replace a more general speech-language billing code on Jan. 1, 2014.

Speech-language pathologists have been using CPT 92506 (Current Procedural Terminology © American Medical Association), Evaluation of speech, language, voice, communication, and/or auditory processing, for a variety of evaluations. Four more specific codes will replace it:

  • 92521, Evaluation of speech fluency (stuttering, cluttering).
  • 92522, Evaluation of speech sound production (articulation, phonological process, apraxia, dysarthria).
  • 92523, Evaluation of speech sound production (articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (receptive and expressive language).
  • 92524, Behavioral and qualitative analysis of voice and resonance.

Medicare, Medicaid and private insurers use CPT codes as the basis for reimbursement of health care procedures. Medicare reimbursement rates associated with these codes will be included in the 2014 Medicare Physicians Fee Schedule, scheduled for release this month.

ASHA has been working with the AMA to change most speech-language pathology codes since 2009, when new laws took effect that allow private-practice SLPs to bill Medicare directly for their services. Because of that change, the AMA's Relative Value Update Committee re-evaluated the reimbursement rates for speech-language pathology codes to include a "professional work" value (one of three components of a code's value). Prior to 2009, SLPs were considered "technical support," and their work was included in the "practice expense" component of the code. During this process, the RUC identified the need for more specific codes to replace CPT 92506; it was difficult to assign a professional work value to a single code that included different types of evaluations.

ASHA will provide more information on the use of these new codes through future Leader articles, Headlines notifications, and the billing and reimbursement webpages. Contact with specific questions.

Medicaid Rules Now Allow Bilateral Softband Bahas

Medicaid will now cover bilateral—not just unilateral—softband Baha systems, under a rule change to be published in January 2014. The Centers for Medicare and Medicaid Services announced the change in response to ASHA's request, which cited evidence of the value of bilateral over unilateral systems for children with conductive hearing loss in both ears.


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