Pediatric Coding Alert

Question: Can you give us some guidance for use of CPT 92506, 92507 and 92508? We have been told by Medicaid and Blue Cross that we cannot bill based on time and that these codes take into consideration the time spent.

Montana Subscriber

Answer: For 92506 (evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status), the physician takes a history, including speech development, hearing loss and mental development. A physical examination is performed, as are hearing tests and speech evaluations. The physician assesses any deficits and creates a treatment plan, which may involve speech therapy and hearing aids. CPT codes 92507 (treatment of speech, language, voice, communication, and/or auditory processing disorder [includes aural rehabilitation]; individual) and 92508 (... group, two or more individuals) are for individual and group developmental programs such as speech therapy, sign language or hearing rehabilitation, respectively.

All three of these codes are used for special otorhinolaryngologic services for diagnostic or treatment procedures, typically provided by otolaryngologist. The services include medical diagnostic evaluation and technical procedures. If your physician is truly performing this type of service in addition to an office visit, consider using an evaluation and management (E/M) services code in addition to the speech evaluation. But, an office visit rarely would accompany any of these codes. Codes 92506, 92507 and 92508 do not specify time spent, and this is why the payer does not allow you to consider the amount of time when billing.


Answers to Reader Questions and You Be the Coder contributed by Richard H. Tuck, MD, FAAP, founding chair and member, AAP coding and reimbursement committee; Tom Kent, CMM, CPC, president, Kent Medical Management; and Victoria Jackson, administrator and CEO, Southern Orange County Pediatric Associates.