Allowable SLP Birth to 3 services are identified by the CPT procedure codes listed in the following table.
Note: All codes listed in this chart, if billed with an applicable POS code, are eligible for natural environment enhanced reimbursement. As with Medicare, providers may not submit a claim for services for less than eight minutes. Most procedure codes for SLP services do not have a time increment indicated in their description. Except as noted above, a quantity of "1" indicates a complete service. The daily service limitation for these codes is one.
| Procedure Code | Description | Billing Limitations | ForwardHealth Coverage Criteria |
|---|---|---|---|
| 92507 | Treatment of speech, language, voice, communication, and/or auditory processing disorder (includes aural rehabilitation); individual | Cannot use on the same DOS as 92507 UC. | Therapy addressing communication/cognitive impairments and voice prosthetics should use this code. If treatment focus is aural rehabilitation as a result of a cochlear implant, submit a PA request using the PA/TA, to request code 92507 UC. |
| 92508 | group, two or more individuals | Group is limited to two to four individuals. | |
| 92521 | Evaluation of speech fluency (e.g., stuttering, cluttering) | Evaluation must provide a quantitative and/or qualitative description of the member's fluency level and/or evaluation must provide a measurement of speaking rate such as SPM. Member's fluency may be documented through results of a commercial stuttering severity instrument and/or description of frequency and severity, types of dysfluencies, secondary characteristics, and self-awareness/perception/self-correction. | |
| 92522 | Evaluation of speech sound productions (e.g., articulation, phonological process, apraxia, dysarthria) | Not allowed on the same DOS as 92523. | Evaluation must provide a quantitative and/or qualitative description of member's speech intelligibility. Member's speech sound production may be documented using results of standardized tests, reporting percent of intelligibility by familiar and unfamiliar listeners when context is known and unknown, and/or describing signs and symptoms of disordered sound production. |
| 92523 | with evaluation of language comprehension and expression (e.g., receptive and expressive language) | Not allowed on the same DOS as 92522.
If the member is evaluated only for language, procedure code 92523 should be billed with modifier 52. |
Evaluation must provide a quantitative and/or qualitative description of member's speech intelligibility. Member's abilities may be documented using results of standardized tests, reporting percent of intelligibility by familiar and unfamiliar listeners when context is known and unknown, and/or reporting signs and symptoms of disordered sound production and report of member's receptive and expressive language abilities using standardized test results, norm referenced data, developmental levels, and/or estimate of language age-equivalent levels if formal testing is unable to be completed. |
| 92524 | Behavioral and qualitative analysis of voice and resonance | Evaluation must provide a quantitative and/or qualitative measurement of the member's voice and resonance including but not limited to perceptual ratings of voice quality, pitch, and loudness, and description of member's awareness of vocal problem, and phonatory behaviors.
This procedure does not include instrumental assessment. |
|
| 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 patient for the use of a voice prosthetic device (for example, 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 patient 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 | This code can only be billed in conjunction with 92607. | A maximum of 90 minutes is allowable. The maximum allowable number of units for this service is one unit of 92607 and one unit of 92608. |
| 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 |
* The procedure code description defines this code as one hour. One unit of this code equals 1 hour. If less than one hour is used, bill in decimals to the nearest quarter hour. For example, 45 minutes equals .75 units and 30 minutes equals .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 equals 30 minutes. If less than 30 minutes is used, bill in decimals to the nearest quarter hour. For example, 15 minutes equals .5 units.