Question

I have a question about speech re-evaluation when there has been significant change in a patient in ongoing therapy. We recently spoke to someone in the industry who said they provide speech re-evaluations using CPT code 92506 and are paying for them. Are you familiar with this practice?

Answer

There is no CPT code for speech-language re-evaluations. 92506 is the CPT code you are supposed to use if you perform a formal re-evaluation. Make sure your documentation supports the medical necessity for a formal re-evaluation. You must also keep in mind that all payers may not pay for a second 92506 being billed to them. Be prepared to appeal if the payer denies.

Question

Under Medicare Part B, can SLP's perform an evaluation and treatment on the same day and be reimbursed for both?

Answer

Beginning with Correct Coding Initiative (CCI) Version 10.3 that became effective January 1, 2005 for hospital outpatient departments, CORF's, rehab agencies, and SNF Part B, providers can be reimbursed for both services. Neither CPT code requires modifier-59 be appended to it in order to be reimbursed. Prior to January 1, 2005, speech treatment (CPT code 92507) was not reimbursed by Medicare if provided on the same day as the speech evaluation (CPT code 92506)