Reporting SLP Services Using Service-Based CPT Codes
Introduction
Speech-language pathology Current Procedural Terminology (CPT) codes are primarily service-based. There are CPT codes that are reported by speech-language pathologists that are time-based:
- the first hour of a speech-generating device (SGD) evaluation,
- each additional 30 minutes of the SGD evaluation,
- aphasia evaluation, per hour,
- the first hour of an aural rehabilitation evaluation, and
- each additional 15 minutes of the aural rehabilitation evaluation.
All other codes are procedure-based. That is, the CPT code is reported once regardless of the length of the appointment.
In the past, some payers including Medicare for institutional settings, paid for speech-language pathology services using time units, usually 15-minute units. Thus, a speech-language pathologist might have been able to bill for 3 units of therapy, or 45 minutes. Now, payers are gradually implementing payment policies based on strict CPT (Current Procedural Terminology codebook) descriptors; if there is no time designated in the official descriptor, the code represents a typical session. One reason for the change is the Health Insurance Portability & Accountability Act (HIPAA) that requires providers to comply with coding guidelines of the American Medical Association (AMA) CPT procedure codes and the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis codes. The number of health plans reviewing, auditing, and changing billing policies regarding eliminating time units has increased dramatically in recent years.
ASHA suggests that speech-language pathologists take a proactive approach using the following strategies and information when you are advised by payers that there are no time components associated with most speech-language pathology and audiology CPT codes.
Converting from Timed to Untimed CPT Codes: Suggested Strategies
FAQs on Timed & Untimed CPT Codes
Converting from Timed to Untimed CPT Codes: Negotiating an Equitable Payment Rate
