Provider Notice issued 01/24/14

Speech Therapy Evaluation Codes

The purpose of this notice is to inform providers of changes to the Speech Therapy Evaluation Codes effective January 1, 2014.

Speech Evaluation CPT Code 92506 was replaced with 4 new more specific codes effective January 1, 2014. As a result the four new codes, as well as several other speech evaluation codes that were previously cross walked to Code 92506, are billable effective with dates of service January 1, 2014. The codes being added to the therapy fee schedule and their descriptions are as follows:

• 92520 – Laryngeal function studies

• 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

• 92597 - Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech

• 92605 - Evaluation for prescription of non-speech-generating augmentative & alternative communication device, first hour

• 92618* - each additional 30 min. of 92605

• 92607 - Evaluation for prescription for speech-generating augmentative & alternative communication device, first hour

• 92608* each additional 30 min of 92607

• 92610 - Evaluation of oral & pharyngeal swallowing function

• 92611 - Motion fluoroscopic evaluation of swallowing function by cine or video recording

• 92626 – Evaluation of auditory rehabilitation status ; first hour

• 92627* – each additional 15 min of 92626

• 96105 - Assessment of aphasia (including assessment of expressive & receptive speech & language function, speech production ability, reading, spelling, writing, eg, by Boston diagnostic Aphasia Examination) with interpretation and report, per hour

• 96110 - Developmental screening, w/interpretation & report, per standardized instrument form

• 96111 - Developmental testing, (includes assessment of motor, language, social, adaptive &/or cognitive functioning by standardized developmental instruments) with interpretation and report.

• 96125 - Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these tests results and preparing the report.

  *Service not covered for adults age 21 and over.

The department is not changing the billing procedures with the opening of the new speech evaluation codes. The evaluations must still be billed in 15 minute increments with 1 unit representing 15 minutes. For the add-on codes 92608 and 92618, for which the code definition includes "each additional 30 minutes", only a unit quantity of 2 (30 min) or 4 (60 min) may be billed. The revised Therapy Fee Schedule and Code Crosswalk will be posted in the near future on the Healthcare and Family Services Medicaid Reimbursement web page.

Any questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 1-877-782-5565, option 3, then option 5.

Theresa A. Eagleson, Administrator

Division of Medical Programs