LCD Reference Article Billing and Coding Article

Billing and Coding: Speech-Language Pathology

A52866

Expand All | Collapse All
Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

Document Note

Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A52866
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Speech-Language Pathology
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
10/01/2021
Revision Ending Date
N/A
Retirement Date
N/A

CPT codes, descriptions, and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2024, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution, or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

N/A

Article Guidance

Article Text

This article contains coding and other guidelines that complement the Local Coverage Determination (LCD) for Speech-Language Pathology.

National Coverage Provisions

Speech-language pathology services are those services provided within the scope of practice of speech-language pathologists and necessary for the diagnosis and treatment of speech and language disorders, which result in communication disabilities and for the diagnosis and treatment of swallowing disorders (dysphagia), regardless of the presence of a communication disability. (See CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Part 3, Section 170.3) (CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 230.3(A))

A qualified speech-language pathologist for program coverage purposes meets one of the following requirements:

  • The education and experience requirements for a Certificate of Clinical Competence in (speech-language pathology) granted by the American Speech-Language Hearing Association; or
  • Meets the educational requirements for certification and is in the process of accumulating the supervised experience required for certification

(CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 230.3(B))An SLP normally has a master's degree and a Certificate of Clinical Competence (CCC-SLP) or all the requirements leading to a Certificate of Clinical Competence, that is, he or she is in their clinical fellowship year (CFY-SLP).

Speech-language pathology services may be considered reasonable and necessary when the following criteria are met:

  • The services shall be considered under accepted standards of medical practice to be a specific and effective treatment for the patient's condition;

  • The services shall be of such a level of complexity and sophistication or the condition of the patient shall be such that the services required can be safely and effectively performed only by a qualified therapist;
  • If the contractor determines the services furnished were of a type that could have been safely and effectively performed only by or under the supervision of such a qualified professional, the contractor shall presume that such services were properly supervised when required. However, this presumption is rebuttable, and, if in the course of processing a claim, the contractor finds that services were not being furnished under proper supervision, it shall deny the claim and bring this matter to the attention of the Division of Survey and Certification of the Regional Office;

  • While a beneficiary's particular medical condition is a valid factor in deciding if skilled therapy services are needed, a beneficiary's diagnosis or prognosis cannot be the sole factor in deciding that a service is or is not skilled. The key issue is whether the skills of a qualified therapist are needed to treat the illness or injury, or whether the services can be carried out by nonskilled personnel. Medicare coverage does not turn on the presence or absence of a beneficiary’s potential improvement from the therapy, but rather on the beneficiary’s need for skilled care; and

  • The amount, frequency, and duration of the services must be reasonable under accepted standards of practice. The contractor shall consult local professionals or the state or national therapy associations in the development of any utilization guidelines and any one or more of the following:
  1. In the case of rehabilitative therapy, the patient’s condition has the potential to improve or is improving in response to therapy, maximum improvement is yet to be attained; and there is an expectation that the anticipated improvement is attainable in a reasonable and generally predictable period of time; or

  2. The services must be necessary for the establishment of a safe and effective maintenance program required in connection with a specific disease state including evaluation, plan of treatment, and staff and family training, when the skills of an SLP are required; or

  3. In the case of a progressive degenerative disease, service may be intermittently necessary to determine the need for assistive equipment and/or establish a program to maximize function; or

  4. In the case of maintenance therapy, treatment by the therapist is necessary to maintain, prevent or slow further deterioration of the patient’s functional status and the services cannot be safely carried out by the beneficiary him or herself, a family member, another caregiver or unskilled personnel.

Evaluation of Language Disorders:

Re-evaluations are usually focused on the current treatment and might not be as extensive as initial evaluations. Continuous assessment of the patient's progress is a component of ongoing therapy services and is not payable as a re-evaluation. A re-evaluation is not a routine, recurring service but is focused on evaluation of progress toward current goals, making a professional judgment about continued care, modifying goals and/or treatment or terminating services. A formal re-evaluation is covered only if the documentation supports the need for further tests and measurements after the initial evaluation. Indications for a re-evaluation include new clinical findings, a significant change in the patient's condition, or failure to respond to the therapeutic interventions outlined in the plan of care.

A re-evaluation may be appropriate prior to planned discharge for the purposes of determining whether goals have been met, or for the use of the physician or the treatment setting at which treatment will be continued.

A re-evaluation is focused on evaluation of progress toward current goals and making a professional judgment about continued care, modifying goals and/or treatment or terminating services. Reevaluation requires the same professional skills as evaluation. The minutes for re-evaluation are documented in the same manner as the minutes for evaluation. Current Procedural Terminology does not define a re-evaluation code for speech-language pathology; use the evaluation code. (CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 220.3.C)

Aural Rehabilitation:

The terms, aural rehabilitation, auditory rehabilitation, auditory processing, lipreading and speech reading are among the terms used to describe covered services related to perception and comprehension of sound through the auditory system. (CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 230.3.D.3)


Coding Guidelines:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare.

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act.

The diagnosis code(s) must best describe the patient's condition for which the service was performed. 

Under the Medicare Program, an independently practicing speech pathologist may now bill the Medicare program directly. Section 143 of the Medicare Improvements for Patients and Provider’s Act of 2008 (MIPPA) authorizes the Centers for Medicare & Medicaid Services (CMS) to enroll speech-language pathologists (SLP) as suppliers of Medicare services and for SLPs to begin billing Medicare for outpatient speech-language pathology services furnished in private practice beginning July 1, 2009. Enrollment will allow SLPs in private practice to bill Medicare and receive direct payment for their services. Previously, the Medicare program could only pay SLP services if an institution, physician or nonphysician practitioner billed them.

However, the services of speech-language pathologists may continue to be billed by providers such as rehabilitation agencies, HHAs, CORFs, hospices, outpatient departments of hospitals, and suppliers such as physicians, non-physician practitioners (NPPs), physical and occupational therapists in private practice. When these services are billed by physicians or NPPs, they are covered when billed under the "incident to" provision. "Incident to" services or supplies are defined as those furnished as an integral, although incidental, part of the physician's or NPPs personal professional services in the course of diagnosis or treatment of an injury or illness. These services must be related directly and specifically to a written treatment regimen established by the physician/NPP, after any needed consultation with a qualified speech pathologist, or by the speech pathologist providing such services.

The Medicare Physician Fee Schedule is the method of payment for outpatient physical therapy (which includes outpatient speech-language pathology). Providers must use modifier -GN to identify service delivered personally by a speech-language pathologist or under an outpatient speech-language pathology Plan of Care. (CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 5, Section 20.1)

For treatment of auditory processing disorders or auditory rehabilitation/auditory training (including speech-reading or lip-reading), 92507, and 92508 are used to report a single encounter with "1" as the unit of service, regardless of the duration of the service on a given day. These codes always represent SLP services. (CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.3.C)

CPT codes 92626 and 92627 have been added at the end of the comment period at the request of several commenters and are not restricted by the list of ICD-10-CM codes that support medical necessity.

ICD-10-CM code Z01.818 should be reported for pre-laryngectomy examinations.

Standardized cognitive performance testing (CPT code 96125) may be billed to assess cognitive status. 

Documentation Requirements:

The patient's medical record must contain documentation that fully supports the medical necessity for services included within the LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. Not only should documentation describe the condition of the patient that necessitates the skilled intervention of the speech-language pathologist, but should also report clinical judgment and describe the skilled nature of the treatment. Documenting the skilled components of activities will assist in supporting that the services are medically necessary.

Documentation of speech language services, like other therapy services, must be objective, clear and concise. Documentation in the clinical record must be descriptive, clearly related to functionality, and complement and correlate with other disciplines. Medical necessity may not be established if there is conflicting documentation between disciplines or widely fluctuating abilities indicating an unstable condition. Prior level of functioning must be documented and considered in the patient's treatment plan, to establish reasonable goals for the patient's present condition. Statements such as "mildly impaired to moderately impaired" or "fair plus to good minus" do not offer sufficient objective and measurable information to assess response to therapy and may result in denial of services as not medically necessary. Documentation of discharge planning should be indicated early in the treatment plan.

Rehabilitative Therapy:

When the goals of therapy are rehabilitative and a valid expectation of improvement existed at the time services were initiated, or thereafter, the services may be covered even though the expectation may not be realized. Progress reports must document a continued reasonable expectation that the patient's condition will improve significantly, i.e., a measurable and substantial increase in the patient's level of communication, independence, and functional competence compared to the level when treatment was initiated. Documentation should include whatever is deemed pertinent to justify the need for continued intervention, such as any improvements, setbacks, and intervening medical complications.

Maintenance Therapy:

When the goals of therapy are to assist a beneficiary in maximizing or maintaining the progress he or she has made during therapy or to prevent or slow further deterioration due to a disease or illness (maintenance), and a valid expectation existed at the time services were initiated that skilled therapy intervention would achieve such goals, the services may be covered even though the expectation may not be realized. The record should also make clear why the services cannot be safely carried out by the beneficiary him or herself, a family member, another caregiver or unskilled personnel. Progress reports must document a continued reasonable expectation that the maintenance therapy goals are reasonable and achievable and that the skills of a therapist are required to meet those goals. Documentation should include whatever is deemed pertinent to justify the need for continued intervention, such as any improvements, setbacks, and intervening medical complications.

For additional information on Medicare documentation requirements for speech-language pathology services see: CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section, 220, including the subsections under Section 220.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Code Description

Please accept the License to see the codes.

N/A

CPT/HCPCS Codes

Please accept the License to see the codes.

N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(169 Codes)
Group 1 Paragraph

The correct use of an ICD-10-CM code does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in the related determination.

ICD-10-CM code Z01.818 should be reported for a pre-laryngectomy examination.

Group 1 Codes
Code Description
F80.0 Phonological disorder
F80.1 Expressive language disorder
F80.2 Mixed receptive-expressive language disorder
F80.4 Speech and language development delay due to hearing loss
F80.81 Childhood onset fluency disorder
F80.89 Other developmental disorders of speech and language
F81.0 Specific reading disorder
F81.2 Mathematics disorder
F81.81 Disorder of written expression
F81.89 Other developmental disorders of scholastic skills
F82 Specific developmental disorder of motor function
F88 Other disorders of psychological development
F98.5 Adult onset fluency disorder
G52.1 Disorders of glossopharyngeal nerve
G52.2 Disorders of vagus nerve
G52.3 Disorders of hypoglossal nerve
G52.7 Disorders of multiple cranial nerves
G52.8 Disorders of other specified cranial nerves
G60.8 Other hereditary and idiopathic neuropathies
H90.0 Conductive hearing loss, bilateral
H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.3 Sensorineural hearing loss, bilateral
H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.5 Unspecified sensorineural hearing loss
H90.6 Mixed conductive and sensorineural hearing loss, bilateral
H90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.72 Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.A11 Conductive hearing loss, unilateral, right ear with restricted hearing on the contralateral side
H90.A12 Conductive hearing loss, unilateral, left ear with restricted hearing on the contralateral side
H90.A21 Sensorineural hearing loss, unilateral, right ear, with restricted hearing on the contralateral side
H90.A22 Sensorineural hearing loss, unilateral, left ear, with restricted hearing on the contralateral side
H90.A31 Mixed conductive and sensorineural hearing loss, unilateral, right ear with restricted hearing on the contralateral side
H90.A32 Mixed conductive and sensorineural hearing loss, unilateral, left ear with restricted hearing on the contralateral side
H91.10 Presbycusis, unspecified ear
H91.93 Unspecified hearing loss, bilateral
H93.25 Central auditory processing disorder
H93.91 Unspecified disorder of right ear
H93.92 Unspecified disorder of left ear
H93.93 Unspecified disorder of ear, bilateral
I69.010 Attention and concentration deficit following nontraumatic subarachnoid hemorrhage
I69.011 Memory deficit following nontraumatic subarachnoid hemorrhage
I69.012 Visuospatial deficit and spatial neglect following nontraumatic subarachnoid hemorrhage
I69.013 Psychomotor deficit following nontraumatic subarachnoid hemorrhage
I69.014 Frontal lobe and executive function deficit following nontraumatic subarachnoid hemorrhage
I69.015 Cognitive social or emotional deficit following nontraumatic subarachnoid hemorrhage
I69.018 Other symptoms and signs involving cognitive functions following nontraumatic subarachnoid hemorrhage
I69.019 Unspecified symptoms and signs involving cognitive functions following nontraumatic subarachnoid hemorrhage
I69.020 Aphasia following nontraumatic subarachnoid hemorrhage
I69.021 Dysphasia following nontraumatic subarachnoid hemorrhage
I69.022 Dysarthria following nontraumatic subarachnoid hemorrhage
I69.023 Fluency disorder following nontraumatic subarachnoid hemorrhage
I69.028 Other speech and language deficits following nontraumatic subarachnoid hemorrhage
I69.091 Dysphagia following nontraumatic subarachnoid hemorrhage
I69.092 Facial weakness following nontraumatic subarachnoid hemorrhage
I69.110 Attention and concentration deficit following nontraumatic intracerebral hemorrhage
I69.111 Memory deficit following nontraumatic intracerebral hemorrhage
I69.112 Visuospatial deficit and spatial neglect following nontraumatic intracerebral hemorrhage
I69.113 Psychomotor deficit following nontraumatic intracerebral hemorrhage
I69.114 Frontal lobe and executive function deficit following nontraumatic intracerebral hemorrhage
I69.115 Cognitive social or emotional deficit following nontraumatic intracerebral hemorrhage
I69.118 Other symptoms and signs involving cognitive functions following nontraumatic intracerebral hemorrhage
I69.119 Unspecified symptoms and signs involving cognitive functions following nontraumatic intracerebral hemorrhage
I69.120 Aphasia following nontraumatic intracerebral hemorrhage
I69.121 Dysphasia following nontraumatic intracerebral hemorrhage
I69.122 Dysarthria following nontraumatic intracerebral hemorrhage
I69.123 Fluency disorder following nontraumatic intracerebral hemorrhage
I69.128 Other speech and language deficits following nontraumatic intracerebral hemorrhage
I69.191 Dysphagia following nontraumatic intracerebral hemorrhage
I69.192 Facial weakness following nontraumatic intracerebral hemorrhage
I69.210 Attention and concentration deficit following other nontraumatic intracranial hemorrhage
I69.211 Memory deficit following other nontraumatic intracranial hemorrhage
I69.212 Visuospatial deficit and spatial neglect following other nontraumatic intracranial hemorrhage
I69.213 Psychomotor deficit following other nontraumatic intracranial hemorrhage
I69.214 Frontal lobe and executive function deficit following other nontraumatic intracranial hemorrhage
I69.215 Cognitive social or emotional deficit following other nontraumatic intracranial hemorrhage
I69.218 Other symptoms and signs involving cognitive functions following other nontraumatic intracranial hemorrhage
I69.219 Unspecified symptoms and signs involving cognitive functions following other nontraumatic intracranial hemorrhage
I69.220 Aphasia following other nontraumatic intracranial hemorrhage
I69.221 Dysphasia following other nontraumatic intracranial hemorrhage
I69.222 Dysarthria following other nontraumatic intracranial hemorrhage
I69.223 Fluency disorder following other nontraumatic intracranial hemorrhage
I69.228 Other speech and language deficits following other nontraumatic intracranial hemorrhage
I69.291 Dysphagia following other nontraumatic intracranial hemorrhage
I69.292 Facial weakness following other nontraumatic intracranial hemorrhage
I69.310 Attention and concentration deficit following cerebral infarction
I69.311 Memory deficit following cerebral infarction
I69.312 Visuospatial deficit and spatial neglect following cerebral infarction
I69.313 Psychomotor deficit following cerebral infarction
I69.314 Frontal lobe and executive function deficit following cerebral infarction
I69.315 Cognitive social or emotional deficit following cerebral infarction
I69.318 Other symptoms and signs involving cognitive functions following cerebral infarction
I69.319 Unspecified symptoms and signs involving cognitive functions following cerebral infarction
I69.320 Aphasia following cerebral infarction
I69.321 Dysphasia following cerebral infarction
I69.322 Dysarthria following cerebral infarction
I69.323 Fluency disorder following cerebral infarction
I69.328 Other speech and language deficits following cerebral infarction
I69.391 Dysphagia following cerebral infarction
I69.392 Facial weakness following cerebral infarction
I69.810 Attention and concentration deficit following other cerebrovascular disease
I69.811 Memory deficit following other cerebrovascular disease
I69.812 Visuospatial deficit and spatial neglect following other cerebrovascular disease
I69.813 Psychomotor deficit following other cerebrovascular disease
I69.814 Frontal lobe and executive function deficit following other cerebrovascular disease
I69.815 Cognitive social or emotional deficit following other cerebrovascular disease
I69.818 Other symptoms and signs involving cognitive functions following other cerebrovascular disease
I69.819 Unspecified symptoms and signs involving cognitive functions following other cerebrovascular disease
I69.820 Aphasia following other cerebrovascular disease
I69.821 Dysphasia following other cerebrovascular disease
I69.822 Dysarthria following other cerebrovascular disease
I69.823 Fluency disorder following other cerebrovascular disease
I69.828 Other speech and language deficits following other cerebrovascular disease
I69.891 Dysphagia following other cerebrovascular disease
I69.892 Facial weakness following other cerebrovascular disease
I69.910 Attention and concentration deficit following unspecified cerebrovascular disease
I69.911 Memory deficit following unspecified cerebrovascular disease
I69.912 Visuospatial deficit and spatial neglect following unspecified cerebrovascular disease
I69.913 Psychomotor deficit following unspecified cerebrovascular disease
I69.914 Frontal lobe and executive function deficit following unspecified cerebrovascular disease
I69.915 Cognitive social or emotional deficit following unspecified cerebrovascular disease
I69.918 Other symptoms and signs involving cognitive functions following unspecified cerebrovascular disease
I69.919 Unspecified symptoms and signs involving cognitive functions following unspecified cerebrovascular disease
I69.920 Aphasia following unspecified cerebrovascular disease
I69.922 Dysarthria following unspecified cerebrovascular disease
I69.928 Other speech and language deficits following unspecified cerebrovascular disease
I69.990 Apraxia following unspecified cerebrovascular disease
J38.01 Paralysis of vocal cords and larynx, unilateral
J38.02 Paralysis of vocal cords and larynx, bilateral
J38.2 Nodules of vocal cords
J38.3 Other diseases of vocal cords
J38.5 Laryngeal spasm
K21.9 Gastro-esophageal reflux disease without esophagitis
R05.1 Acute cough
R05.2 Subacute cough
R05.3 Chronic cough
R13.0* Aphagia
R13.10* Dysphagia, unspecified
R13.11* Dysphagia, oral phase
R13.12* Dysphagia, oropharyngeal phase
R13.13* Dysphagia, pharyngeal phase
R13.14* Dysphagia, pharyngoesophageal phase
R13.19* Other dysphagia
R41.840 Attention and concentration deficit
R41.841 Cognitive communication deficit
R41.842 Visuospatial deficit
R41.843 Psychomotor deficit
R41.844 Frontal lobe and executive function deficit
R41.89 Other symptoms and signs involving cognitive functions and awareness
R47.01 Aphasia
R47.02 Dysphasia
R47.1 Dysarthria and anarthria
R47.81 Slurred speech
R47.82 Fluency disorder in conditions classified elsewhere
R47.89 Other speech disturbances
R48.0 Dyslexia and alexia
R48.1 Agnosia
R48.2 Apraxia
R48.8 Other symbolic dysfunctions
R49.0 Dysphonia
R49.1 Aphonia
T85.898A Other specified complication of other internal prosthetic devices, implants and grafts, initial encounter
T85.898D Other specified complication of other internal prosthetic devices, implants and grafts, subsequent encounter
T85.898S Other specified complication of other internal prosthetic devices, implants and grafts, sequela
Z01.818 Encounter for other preprocedural examination
Z44.8 Encounter for fitting and adjustment of other external prosthetic devices
Z96.3 Presence of artificial larynx
Z97.4 Presence of external hearing-aid
Group 1 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*ICD-10-CM codes R13.0, R13.10, R13.11, R13.12, R13.13, R13.14 and R13.19 are only covered for CPT codes 92507, 92521, 92522, 92523 and 92524.

N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description

Please accept the License to see the codes.

N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description

Please accept the License to see the codes.

N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
10/01/2021 R7

Due to the annual ICD-10 updates, ICD-10 code R05 has been deleted from Group 1 in the ICD-10 codes that support medical necessity section, and the following codes have been added: R05.1, R05.2, and R05.3.

01/01/2020 R6

Due to annual CPT/HCPC Updates, CPT code G0515 has been deleted from "CPT/HCPCS Codes" section Group 1 and the following new codes were added; 97129 and 97130. The descriptors have been changed for CPT codes 92626 and 92627.

12/19/2019 R5

This article was converted to the new Billing and Coding Article format.

Bill types and Revenue codes have been removed from this article. Guidance on these codes is available in the Bill type and Revenue code sections.

Asterisks were added to R13.0, R13.10, R13.11, R13.12, R13.13, R13.14 and R13.19 for clarification.

01/01/2019 R4

Due to the annual CPT/HCPCS update, CPT code 96111 was deleted from the "CPT/HCPCS Codes" section and the following new codes were added; 96112 and 96113.

01/01/2018 R3

Due to the annual HCPCS update, CPT code 97532 was deleted and removed from the “CPT/HCPCS Codes” section. An explanatory note regarding the code deletion was added to this section. HCPCS code G0515 was added as the replacement code.

Removed template language.

01/01/2017 R2 Due to annual HCPCS update, the descriptor was changed for CPT code 31579.
10/01/2015 R1 Removed place of service coding guidelines.
N/A

Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L33580 - Speech-Language Pathology
Related National Coverage Documents
N/A
SAD Process URL 1
N/A
SAD Process URL 2
N/A
Statutory Requirements URLs
N/A
Rules and Regulations URLs
N/A
CMS Manual Explanations URLs
N/A
Other URLs
N/A
Public Versions
Updated On Effective Dates Status
09/24/2021 10/01/2021 - N/A Currently in Effect You are here
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

N/A