Eli's Rehab Report

Published on Sat Jan 01, 2005 PDF

Question: Does Medicare bundle speech evaluation and speech therapy?

Florida Subscriber

Answer: Medicare does not bundle speech evaluation (92506, Evaluation of speech, language, voice, communication, auditory processing, and/or aural rehabilitation status) and speech therapy (92507, Treatment of speech, language, voice, communication, and/or auditory processing disorder [includes aural rehabilitation]; individual). National Correct Coding Initiative (NCCI), version 10.3, separated these codes, effective Oct. 1, 2004.
 
This means that speech therapists can provide both an evaluation and management service as well as a treatment  on the same day and expect reimbursement for both services. You do not need to add modifier -59 (Distinct procedural service) to either CPT code, but make sure you have documentation showing how both the services were medically necessary for the patient.
 
Note: This NCCI edit affects physical and occupational therapists in private practices and physician-owned clinics. If you're coding in a hospital outpatient therapy department, SNF, CORF, home health agency billing    Part B, or rehab agency, you can expect this change to take place Jan. 1, 2005 - one calendar quarter behind edits used by Medicare carriers.