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96110 / g0451 -new CMS update

  1. Question 96110 / g0451 -new CMS update
    Medical Coding Books
    Can you explain the new CMS update regarding using 96110 and the new created code G0451. This was issued on 12-29-11. thanks

  2. #2
    Columbia, MO
    This is from ASHA:
    New and Revised CPT Codes For 2012
    Speech-Language Pathology

    The following are changes and additions to CPT codes that will be effective January 1, 2012. We are including comments from the Centers for Medicare and Medicaid Services (CMS) regarding the CPT coding changes because health plans may adopt Medicare coding rules.
    New & Revised Codes

    92605 Evaluation for prescription of non-speech-generating augmentative and alternative communication device, [face-to-face with the patient; first hour] (Revised)
    92618 Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient, each additional 30 minutes (New add-on code to 92605; list separately in addition to code for primary procedure)

    96110 Developmental [screening], with interpretation and report, [per standardized instrument form] (Revised)
    96111 Developmental testing, (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report (Revised)

    Medicare Notes

    Medicare does not separately pay for CPT codes 92605 or 92618. Medicare considers these service as always bundled into payment for other services not specified.
    Medicare no longer covers 96110 because its policy is to not cover screens. However, CMS did allow a way for Medicare to pay for developmental screening by also proposing to add a temporary code, a supplemental HCPCS Level II G-code, G0451 Developmental testing with interpretation and report, per standardized instrument, which is valued on the previously-published values of CPT code 96110. Medicare is required to pay G codes. Medicaid and private payers will often, but not always, follow suit. There is no guarantee of continued reimbursement, but G0451 may be an alternative to 96110. Because of the potential for confusion with these codes, documentation should be very clear.

    Debra A. Mitchell, MSPH, CPC-H

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