Eli's Rehab Report

Published on Wed Jan 10, 2007 PDF

Question: Should I use timed units (that is, 15-minute units) for speech-language pathology charges? My understanding is that speech codes are not timed.


Mississippi subscriber

Answer: You're partly right -- most speech codes are not timed; rather, they're service-based. An easy way to tell if a code is timed is by looking for the phrase "per hour" or "first hour" in the code's descriptor.

Some examples of timed CPT codes that speech-language pathologists (SLPs) use are 92607 (Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to face with patient; first hour) and 96105 (Assessment of aphasia, [includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination] with interpretation and report, per hour).

You should bill service-based CPT codes only as one unit per day per patient per discipline, regardless of the amount of time the SLP spends providing that service.

Exception: If you provide a service-based intervention twice on the same date but at separate and distinct times, you can bill it twice.
 
For example, an SLP provides 30 minutes of speech treatment (92507) in the morning and treats the patient again in the afternoon for 40 minutes addressing speech treatment. The SLP could bill two units of 92507, but he would have to append modifier 59 (Distinct procedural service) to the second 92507 on the claim form.

Important: The SLP's documentation would not only have to support that the SLP saw the patient twice on the same date of service, but would also have to support why the patient had to have two separate and distinct encounters, as opposed to just one session.

Some payers take the CPT codes used by SLP that are service-based and put them into time-based codes, but this is rare. You usually only see this with state Medicaid programs or state programs that reimburse for pediatric patients receiving SLP services. The time could be 15, 30, or 60 minutes in length per CPT code. Either way, you'll want to check with your payers to see how they reimburse for SLP services.