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
92508 Group Tx $24.54 $22.36
92521 Fluency Eval $115.85 $126.72
92522 Speech Eval $94.55 $106.95
92523 Speech & Language Eval $198.49 $217.46
92524 Behavioral Voice Eval $92.39 $104.36
92526 Swallow Tx $89.50 $80.37
92610 Clinical Bedside $89.14 $81.35
92611 MBS $94.55 $87.83
92612 FEES (without sensory) $203.55 $195.10
96105 Aphasia Assessment $105.74 $94.96
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

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
Concurrent Allowed? Yes No
Resources: ASHA Group Therapy

 

Medicare Benefit Manual

National Government Services Article