Your Guide to Speech Therapy Billing Codes
Speech-language pathologists offer an invaluable service to clients. Without them, issues such as auditory processing disorders, poor swallowing function, and impaired speech sound production would likely go unresolved.
If you offer speech therapy services to clients, it’s important to understand speech therapy billing codes so that Medicare or the insurance company reimburses you for care.
However, CPT codes and medical billing can be incredibly complex. CPT codes frequently change, and the payer will deny you reimbursement if you claim the wrong one.
Below, you’ll learn about some of the most common CPT codes for speech therapy and how to address claim denials for patient services.
Understanding Speech Therapy Billing Codes
If you’re new to speech therapy billing and CPT codes, it’s easy to feel overwhelmed. The following are the basics of what speech-language pathologists should know.
The Role of CPT in Speech Therapy
CPT stands for “Current Procedural Terminology.” The American Medical Association is responsible for developing and managing all CPT codes, including those for speech therapy.
When working with a patient, you may bill timed or untimed CPT codes. With timed codes, payers reimburse providers for constant one-on-one, face-to-face time with patients. Timed codes only include skilled interventions, and you can bill them multiple times per session.
Untimed codes are session-based, not time-based. You can only bill for these codes once per session, and you can only bill one unit regardless of how much time you spend with the patient. It’s also possible to have certain CPT code pairs that include timed and untimed codes.
For ease of billing, providers must bill timed codes as units. You’d bill one unit for eight to 22 minutes of one-on-one time. For 23 to less than 37 minutes, you’d bill two units, and so on.
How can you know whether you should use a timed or untimed code? If your CPT manual lists some unit of time for a procedure, you should use timed codes. For instance, if the manual notes “15 minutes of physical therapy,” you would report a timed CPT code.
Commonly Used Speech Therapy Billing Codes
Speech therapists will use some procedure codes more frequently than others. Commonly used CPT codes include the following:
- 92507: Treatment of speech, language, voice communication, and/or auditory processing disorder. This code applies if a patient has problems evaluating speech sounds. Use code 92507 for speech therapy, sign language, hearing rehabilitation, and lip-reading instruction.
- 92520: Laryngeal function studies (includes instrumental assessment of voice and resonance).
- 92521: Evaluation of speech fluency. This code covers the evaluation of speech communication disorders, such as stuttering. Providers must evaluate oral function with a quantitative and qualitative analysis to use this code.
- 92523: Speech sound production and expressive language. This code covers the evaluation of expressive language comprehension, articulation, the phonological process, verbal expression, and written communication.
- 92526: Treatment of swallowing dysfunction and/or oral function for feeding. Use this code if a patient has a physiological swallowing problem.
- 92605: Evaluation for prescription of non-speech-generating augmentative and alternative communication device. This is a time-based CPT code. Use code 92605 for the first hour of non-speech generating augmentation evaluation, then 92618 for extra time in 30-minute increments.
- 92606: Therapeutic services for the use of a non-speech-generating device/alternative communication device. Use this code if you are setting up or modifying a non-speech-generating or alternative communication device for a patient.
- 96112: Developmental test administration of executive function, cognitive function, memory, language, and fine/gross motor skills. Use this code for the first hour and code 96113 for every 30 minutes after that.
- 97129: Therapeutic interventions that focus on cognitive functioning and compensatory strategies to manage the performance of an activity. Compensatory strategies may include organizing sequencing tasks and managing schedules.
- 97533: Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands (billed per 15 minutes).
- 98975: Remote therapeutic monitoring (including therapy response and therapy adherence); first-time setup and patient education on the use of equipment.
- 98977: Remote therapeutic monitoring and device supply with scheduled recordings and/or programmed alerts to monitor the musculoskeletal system. Use code 98976 for alerts to monitor the respiratory system.
- 98980: Remote therapeutic monitoring requiring interactive communication with the patient/caregiver at least once per month.
Understanding these commonly used billing codes is crucial for speech therapists, as they directly influence claims processing and reimbursement, and it’s important to consider the impact of ICD-10-CM updates on speech therapy billing.
Navigating Through Billing Code Changes
Speech-language therapy codes change often, and it’s important to stay updated to keep your patient’s medical record as accurate as possible. Plus, your payer will not reimburse you if you bill your therapeutic services or surgical procedures improperly. Dealing with denials can be a major headache for any speech-language pathology practice.
Impact of ICD-10-CM on Speech Therapy Billing
The ICD, or International Classification of Diseases, serves as a catalog of medical conditions. As a speech-language pathologist, you’ll use the ICD to help you identify procedures, symptoms, and diagnoses for claims processing.
In October 2015, the National Center for Health Statistics updated ICD-9-CM to ICD-10-CM. Changes include:
- Expanded injury codes
- More specificity in assignment for procedure codes
- Updates to external causes of morbidity, which pertain to sharp objects, metal, plastic, glass, and batteries entering through an orifice, such as the mouth or ears
- Updates to factors influencing health status
- More information for managed care and ambulatory care encounters
As speech-language pathologists navigate the often-changing landscape of billing codes, it’s imperative to understand the complexities introduced by updates like ICD-10-CM for accurate patient records and reimbursement. This leads us to explore specific strategies for ensuring precise billing, where documentation best practices play a pivotal role.
Strategies for Accurate Speech Therapy Billing
For thorough medical billing, it’s important to maintain good documentation and use CPT modifiers correctly. We explain how to do this below.
Documentation Best Practices
Accurate medical documentation is critical for your speech-language pathology services. Without proper documentation, the payer may not see your therapeutic services as a medical necessity.
Documentation helps speech therapists select the right code for quantitative and qualitative assessments, speech fluency evaluations, speech-language deficit treatments, and other therapy services.
To choose the right code, consider these factors:
- New or established patient
- The extent of the patient’s medical history
- The extent of the exam
- Extent of medical decision making
- Nature of the presenting problem
- Amount of time spent with the patient
- Counseling or coordination of care
Mastering documentation best practices is essential for selecting appropriate codes in speech therapy billing, and correctly utilizing modifiers is an important next step.
Utilizing Modifiers Correctly
Speech therapy modifiers provide additional information to a payer for medical billing purposes. You may use modifiers when CPT codes designated for a primary procedure aren’t enough for reimbursement.
The main modifier you’ll use with CPT codes for speech therapy is the 59 modifier. You use this modifier to differentiate between two services performed in the same session. This modifier indicates that each service was a medical necessity and performed independently.
Other common modifiers are:
- KX: Patients with Medicare have a threshold for therapy services, and once they’ve exceeded the threshold, Medicare usually won’t reimburse them for care. If your patient exceeds this threshold, you can use the KX modifier to indicate that a procedure was medically necessary.
- GO/GN/GP: You may use these modifiers if there is any confusion about who provided a service to a patient. For occupational therapists, use -GO, and for speech-language pathologists, use -GN. Providers of physical therapy should use -GP.
- GA: If a patient has reached a “functional plateau” according to speech therapy evaluations but still wants to receive therapy, you would use the -GA modifier to either bill secondary insurance or the patient directly.
Effectively utilizing modifiers in speech therapy billing is crucial, as it ensures accurate and detailed information for payers, leading to appropriate reimbursement and recognition of the medical necessity of services provided.
Overcoming Billing Challenges in Speech Therapy
Coding errors can be either accidental or purposeful. Either way, these mistakes lead to claim denials. For instance, say you have certain CPT code pairs billed incorrectly. Medicare or the insurance company would deny this claim.
Common reasons for denial include:
- The patient’s insurance doesn’t cover certain speech-language voice procedures.
- The patient needs prior authorization for insurance to approve a service.
- The payer doesn’t deem a speech-language voice communication service medically necessary.
- The claim has missing or incorrect information.
- The patient has more than one health plan, which can cause denials until their coordination of benefits is updated.
- You’ve submitted a duplicate claim.
- You’ve exceeded the payer’s timely filing limit.
- You used an unlisted code without providing supporting documentation.
- You used a time-based code when you should have used a session-based code.
- You billed for more time than you spent with a patient (for example, billing 45 minutes for a language comprehension test when you only spent 20 minutes with the patient).
- You “unbundled” a procedure to bill separate codes. If there is a single code available that accurately depicts a service, you should use that code.
- You overuse modifier 22, Increased Procedural Services, which indicates that a procedure requires more work than usual. You must provide supporting evidence if you use modifier 22.
Now that we’ve identified some common reasons for a denial, here is how to address those claims.
Addressing Claim Denials
- Use the right procedure code for each service. For instance, if you perform an evaluation of speech sound but accidentally bill for pharyngeal swallowing function, you’ll end up with a denial.
- Verify that the patient’s insurance covers each procedure. If insurance requires pre-authorization, get it before performing a service.
- If you get a denial, correct the medical billing error and resubmit the claim. Aim to do this within one week of the denial.
- If you have multiple coding issues and frequent denials, create a team to help you identify trends. Your team should include therapists, nurses, case management, admitting/registration members, and patient financial services.
- Conduct regular performance audits of registration, insurance verification quality, write-off adjustments, remittance advice reviews, and zero-payment claims.
Improve Your Billing Practices With Weave
Understanding speech therapy billing codes is hard enough, and the last thing you need is to waste valuable time hounding patients for payment. Enter Weave, a cutting-edge practice management system that makes collecting payments a snap.
Weave also allows your practice to verify a patient’s insurance instantly without needing to access any other system. With Weave, you’ll spend less time tracking down insurance providers, freeing you up to focus on what matters most: your patients.
See How Weave Can Elevate Your Speech-Language Therapy Practice
If you’d like to avoid time-consuming insurance and Medicare denials, figuring out speech therapy billing codes is a must. If you’re having trouble staying up to date with CPT codes and patient billing, try streamlining your workflow with Weave! Get your free demo of Weave now.
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