Speech Therapy Billing & Credentialing

Speech therapy is a type of therapy that helps individuals who have difficulty with communication, language, or speech-related disorders. Speech therapists, also known as speech-language pathologists, work with individuals of all ages to improve their communication skills.

The therapy sessions may involve exercises to improve pronunciation, vocabulary, and grammar, as well as techniques to help with speaking fluency, such as breathing exercises and relaxation techniques. Speech therapy may also involve working with individuals who have difficulty with swallowing or eating. The goal of speech therapy is to help individuals develop effective communication skills and improve their quality of life.

Speech / Language Pathology Therapy Billing & Credentialing

Billing and Coding for Speech / Language pathology therapy practices are evolving every year. Even with the new 4-level evaluation codes put into place, CMS or U.S. Centers for Medicare Medicaid Services is still collecting data throughout 2017 to see if there need to be more changes made to how SLP Therapists are reimbursed. There are multiple rules and regulations for SLP therapy billing and coding.

Every insurance company is different, which is why checking eligibility, submitting authorizations and documentation and adhering the correct modifiers to your patient’s claims can be a daily task that many offices struggle to learn and understand. Medwave and its professionally trained staff are here to help you and your office succeed in submitting your claims correctly.

Keeping Compliant

The first step to ensuring that you and your speech therapy practice are on the right track is to make sure that you are documenting your patient’s visits correctly. Correctly documenting your patient’s notes can be the difference between getting paid and acquiring authorizations and losing thousands of dollars in income a year.

What should you be including in your documentation?

Most current ICD-10 codes
Updated CPT Evaluation codes
Patient Specific Functional Scale (PSFS)
G- Codes upon Evaluation and Re-evaluation and at least every 10^th

New SLP Evaluation Codes

As of January 1^st, 2014, the CPT code 92506 for a Speech, Language, voice, communication, auditory therapy evaluation was replaced by 4 new CPT codes. The new codes will allow therapists to make a more specific evaluation based on the complexity of the patient’s diagnosis and performance.

New CPT Codes for Speech Therapy

92521 – Evaluation of speech fluency (e.g., stuttering, cluttering)
92522 – Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)
92523 – Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language)
92524 – Behavioral and qualitative analysis of voice and resonance

Patient Specific Functional Scale

The patient-specific functional scale score is being used by multiple insurance companies as a way to properly measure a patient’s functional condition. Before being evaluated, the patient is asked to list as many as three activities they are having trouble performing based upon their diagnosis. Once identified, they will point to a number scale from 0-10, 10 being fully functional, and score how they deem themselves able to perform that activity. This will be completed before the initial evaluation and upon every re-evaluation after.

Patient-specific activity scoring scheme (Point to one number):

0 1 2 3 4 5 6 7 8 9 10

Unable to perform Able to perform

See the following PDF: Highmark Patient Specific Functional Scale

Functional Reporting using G-codes

As of January 1^st, 2013, it is required to append “G” codes to the initial visit, at least every 10^th and upon the discharge of treating a patient under Part B Medicare. Highmark BCBS has now initiated the same policies for tracking the functional limitations of a patient. As of July 2017, all claims will be denied if G-codes and their modifiers are not used.

How do I know which G-code to use?

Based on the patients DX codes, you would choose the corresponding G-codes that best explain the patient’s functional limitations. You will always need to include 2 of the 3 codes in a set. You will either use the current status code with the goal status code or the current status code and discharge code. These codes will also need to be included in the patient’s documentation for every date of service:

Motor Speech G-code set:

G8999 Current Motor Speech Status
G9186 Motor Speech goal status
G9158 Motor Speech D/C status

Spoken Language Comprehension G-code set:

G9159 Lang Comp current status
G9160 Lang Comp goal status
G9161 Lang Comp D/C status

Spoken Language Comprehension G-code set:

G9162 Lang express current status
G9163 Lang express goal status
G9164 Lang express D/C status

Swallowing G-code set:

G8996 Swallow current status
G8997 Swallow goal status
G8998 Swallow D/C status

Voice G-code set:

G9171 Voice current status
G9172 Voice goal status
G9173 Voice D/C status

Severity Modifiers

Modifiers are needed to more accurately show the level of functional status the patient currently has and the goal being reached. There are a total of seven modifiers to choose from:

Modifier Impairment Limitation Restriction

CH – 0 percent impaired, limited or restricted
CI – At least 1 percent but less than 20 percent impaired, limited or restricted
CJ – At least 20 percent but less than 40 percent impaired, limited or restricted
CK – At least 40 percent but less than 60 percent impaired, limited or restricted
CL – At least 60 percent but less than 80 percent impaired, limited or restricted
CM – At least 80 percent but less than 100 percent impaired, limited or restricted
CN – 100 percent impaired, limited or restricted

When submitting claims for Medicare it is still necessary to append the GN modifier to show the service is being performed as outpatient speech-language pathology.

Medwave Billing & Credentialing has a dedicated team of medical billing and credentialing experts to help you maximize your office’s reimbursement and keep you up-to-date with today’s ever-changing medical billing and credentialing regulations. Our team is experienced and well educated in the medical billing and coding guidelines of Speech Therapy and has firsthand experience working with commercial, government, auto and workman’s compensation companies to get your claims paid fast and efficiently.

Our sole objective is to move your office to a more efficient and effective work process so that your claims reimbursement is at its maximum. Utilizing the most current ICD-10 and CPT coding ensures that your office’s claims are clean and paid the first time. Our staff is here to help you and your office succeed in preparing claims and getting reimbursed.