Allowable SLP services are identified by the allowable CPT procedures codes listed in the following table.
Note: All codes listed in this chart, if billed with an applicable place of service code, are eligible for natural environment enhanced reimbursement. Providers may not submit claims for services for less than eight minutes. Most procedure codes for speech and language pathology services do not have a time increment indicated in their description. Except as previously noted, a quantity of "1" indicates a complete service. The daily service limitation for these codes is one.
Procedure Code |
Description |
Billing Limitations |
Additional Conditions |
|
---|---|---|---|---|
31575 |
Laryngoscopy, flexible fiberoptic; diagnostic |
Use this code if the speech-language pathologist actually inserts a laryngoscope. Do not use this code if the speech-language pathologist is providing an analysis and does not insert the laryngoscope; instead, use code 92506 or 92610, as appropriate. For treatment, use 92507 or 92526, as appropriate. This service is to be performed according to the ASHA Code of Ethics and ASHA Training Guidelines for Laryngeal Videoendoscopy/Stroboscopy. |
||
31579 |
Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy |
Use this code if the speech-language pathologist actually inserts a laryngoscope. Do not use this code if the speech-language pathologist is providing an analysis and does not insert the laryngoscope; instead, use code 92506 or 92610 as appropriate. This service is to be performed according to the ASHA Code of Ethics and ASHA Training Guidelines for Laryngeal Videoendoscopy/Stroboscopy. |
||
92506 |
Evaluation of speech, language, voice, communication, and/or auditory processing |
Cannot use on the same DOS as 96105. |
This code is to be used for re-evaluation. Use this code for evaluation of auditory rehabilitation status. |
|
92507 |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
This code should be used for therapy services that address communication/cognitive impairments, voice prosthetics, and auditory rehabilitation. |
||
92507 + UC* |
Treatment of speech, language, voice, communication, and/or auditory processing disorder |
Use this code for aural rehabilitation following a cochlear implant. |
||
92508 |
group, two or more individuals |
"Group speech/language pathology treatment" means the delivery of speech/language pathology treatment procedures limited to the areas of expressive language, receptive language, and hearing/auditory training (auditory training, lip reading, and hearing-aid orientation), in a group setting for up to four BadgerCare Plus members (per DHS 101.03[69], Wis. Admin. Code). |
||
92511 |
Nasopharyngoscopy with endoscope (separate procedure) |
Use this code if the speech-language pathologist actually inserts an endoscope. Do not use this code if the speech-language pathologist is providing an analysis and does not insert the scope; instead, use code 92506 or 92610 as appropriate. Use this code for evaluation of dysphagia or assessment of velopharyngeal insufficiency or incompetence. This service is to be performed according to the ASHA Code of Ethics and ASHA Training Guidelines for Laryngeal Videoendoscopy/Stroboscopy. |
||
92512 |
Nasal function studies (eg, rhinomanometry) |
Use this code if completing aerodynamic studies, oral pressure/nasal airflow, flow/flow studies, or pressure/pressure studies. |
||
92520 |
Laryngeal function studies (ie, aerodynamic testing and acoustic testing) |
Use this code for laryngeal airflow studies, subglottic air pressure studies, acoustic analysis, EGG laryngeal resistance. |
||
92526 |
Treatment of swallowing dysfunction and/or oral function for feeding |
The member must have an identified physiological swallowing and/or feeding problem. This is to be documented using professional standards of practice such as identifying oral phase, esophageal phase, or pharyngeal phase dysphagia, baseline of current swallowing and feeding skills not limited to signs of aspiration, an oral mechanism exam, report of how nutrition is met, current diet restrictions, compensation strategies used, and level of assistance needed. |
||
92597 |
Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech |
Cannot use on the same DOS as 96105. |
This code describes the services to evaluate a member for the use of a voice prosthetic device (e.g., electrolarynx, tracheostomy-speaking valve). Evaluation of picture communication books, manual picture boards, sign language, the Picture Exchange Communication System, picture cards, gestures, etc., are not included in the reimbursement for this code. Instead, use code 92506. |
|
92607** |
Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour |
Cannot use on the same DOS as 96105. |
This code describes the services to evaluate a member to specify the speech-generating device recommended to meet the member's needs and capacity. This can also be used for re-evaluations. Evaluation of picture communication books, manual picture boards, sign language, the Picture Exchange Communication System, picture cards, gestures, etc., are not included in the reimbursement for this code. Instead, use code 92506. |
|
92608*** |
each additional 30 minutes (List separately in addition to code for primary procedure) |
This code can be billed only in conjunction with 92607. |
The maximum allowable number of units for this service is one unit of 92607 and one unit of 92608 (i.e., a maximum of 90 minutes). |
|
92609 |
Therapeutic services for the use of speech-generating device, including programming and modification |
This code describes the face-to-face services delivered to the member to adapt the device to the member and train him or her in its use. |
||
92610 |
Evaluation of oral and pharyngeal swallowing function |
|||
92611 |
Motion fluoroscopic evaluation of swallowing function by cine or video recording |
Accompanying a member to a swallow study is not reimbursable. This code involves participation and interpretation of results from the dynamic observation of the member swallowing materials of various consistencies. It is observed fluoroscopically and typically recorded on video. The evaluation involves using the information to assess the member's swallowing function and to develop a treatment. |
||
92612 |
Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording; |
|||
92614 |
Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording; |
Only allowable when used in conjunction with 92612. |
||
92700 |
Unlisted otorhinolaryngological service or procedure |
PA is always required to use this code. Use this code when no other CPT code description appropriately describes the evaluation or treatment. |
||
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 |
Cannot use on the same DOS as 92506, 92597, 92607, or 92608. |
* Use 92507 with modifier "UC" for therapy following a cochlear implant.
** The procedure code description defines this code as one hour. One unit of this code = 1 hour. If less than one hour is used, bill in decimals to the nearest quarter hour. For example, 45 minutes = .75 units and 30 minutes = .5 units. If more than one hour of service is provided, up to one unit of code 92608 can be used in combination with this code.
*** The procedure code description defines this code as 30 minutes. One unit of this code = 30 minutes. If less than 30 minutes is used, bill in decimals to the nearest quarter hour. For example, 15 minutes = .5 units.