CPT code cuts:
There was an average of 9% cuts to speech pathology for Medicare Part B services. There is an excellent explanation of how this came to be in the ASHA resource 2021 Medicare Fee Schedule for Speech-Language Pathologists (attached via hyper link).
|CPT Code||Description||Fee Schedule 2020||Fee Schedule 2021|
|92507||Speech Tx – Individual||$81.20||$72.27|
|92523||Speech & Language Eval||$198.49||$217.46|
|92524||Behavioral Voice Eval||$92.39||$104.36|
|92612||FEES (without sensory)||$203.55||$195.10|
|96125||Standardized Cog Eval||$111.88||$99.49|
|97129||Cog Tx – first 15 min||$24.54||$21.71|
|97130||Cog Tx – additional||$23.46||$21.07|
On average it is a 9% cut to most CPT codes. The four speech, language, voice, fluency evaluation codes actually have 9% increase.
SLP and Telehealth:
There will be 5 CPT codes reimbursable via telehealth starting January 1, 2021. These will only be billable via telehealth while the Public Health Emergency is in place. Currently the Public Health Emergency is set to expire on January 20, 2021. It is very likely that President Elect Biden will extend the public health emergency.
The codes reimbursable are as follows:
92507: Treatment of Speech, language, voice, communication and/or auditory processing disorder; individual
92521: Evaluation of Fluency
92522: Evaluation of speech sound production
92523: Evaluation of speech sound production with evaluation of language comprehension and expression
92524: Behavioral and qualitative analysis of voice and resonance
Group therapy has the following requirements to constitute a group:
- Identify in the plan of care why group setting necessary
- Demonstrate group services are based on clinical need
- Describe patient goals and outcomes
Group therapy for Medicare Part B can be 2 or more of any payor types as long as they are performing the same activity. Concurrent therapy is NOT allowed for Medicare Part B which would be 2 patients who are working at the same time who are NOT performing the same activity.
Concurrent therapy is allowed for Med A but combined Group and Concurrent time can not exceed 25% of the total treatment time for the patient.
Group therapy code is 92508 which is the only approved group therapy code for SLPs per National Government Services (our Medicare intermediary). This code is for speech, language, voice, communication and/or auditory processing of 2 or more people. It does NOT include dysphagia or cognition.
|Payor:||Med A Guidelines||Med B Guidelines|
|Accepted CPT Code:||92508: Speech, Language, voice communication and/or auditory processing||92508: Speech, Language, voice communication and/or auditory processing|
|# of Patients:||2-6 patients||2 or more individuals|
|Special Instructions:||May only account 25% of total tx time over the episode of care||Must be performing the same activity|
|Therapist must be in constant attendance|
|Resources:||ASHA Group Therapy
|Medicare Benefit Manual