LCD Reference Article Billing and Coding Article

Billing and Coding: Home Health Speech-Language Pathology

A53052

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Draft Article
Draft Articles are works in progress and not necessarily a reflection of the current billing and coding practices. Revisions to codes are carefully and thoroughly reviewed and are not intended to change the original intent of the LCD.

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Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A53052
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Home Health Speech-Language Pathology
Article Type
Billing and Coding
Original Effective Date
10/01/2015
Revision Effective Date
01/01/2024
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2023 American Dental Association. All rights reserved.

Copyright © 2023, the American Hospital Association, Chicago, Illinois. Reproduced with permission. No portion of the American Hospital Association (AHA) copyrighted materials contained within this publication may be copied without the express written consent of the AHA. AHA copyrighted materials including the UB‐04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA. If an entity wishes to utilize any AHA materials, please contact the AHA at 312‐893‐6816.

Making copies or utilizing the content of the UB‐04 Manual, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB‐04 Manual and/or codes and descriptions; and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. The American Hospital Association (the "AHA") has not reviewed, and is not responsible for, the completeness or accuracy of any information contained in this material, nor was the AHA or any of its affiliates, involved in the preparation of this material, or the analysis of information provided in the material. The views and/or positions presented in the material do not necessarily represent the views of the AHA. CMS and its products and services are not endorsed by the AHA or any of its affiliates.

CMS National Coverage Policy

Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim.

Title XVIII of the Social Security Act, §1835(a)(2)(A) addresses procedure for payment of claims of providers of services.

CMS Internet-Only Manual, Pub. 100-04, Medicare Claims Processing Manual, Chapter 5, §20 HCPCS Coding Requirement, §20.1 Discipline Specific Outpatient Rehabilitation Modifiers - All Claims, and §20.2 Reporting of Service Units With HCPCS

CMS Internet-Only Manual, Pub. 100-08, Medicare Program Integrity Manual, Chapter 6, §6.2.4 Coding

Article Guidance

Article Text

The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Home Health Speech-Language Pathology L34563

Coding Guidelines

1.When billing for a “Z” code as a diagnosis code, documentation should include (if applicable) the name of the orthotic/prosthetic device, date the patient received the device, and the date training/teaching began.

2. For the purpose of the related LCD, diagnosis code R68.89 should be used when treating memory disturbances not associated with mental disorders (e.g., post cerebrovascular accident (CVA)).

3. As of July 1999, speech-language pathologist (SLP) must report time spent with the patient in 15-minute increments. The following code should be used for SLP:

  • G0153- Speech-Language Pathology

 *Note: Other HCPCS codes found in this article are for informational and descriptive use only.

Re-evaluation

  • Speech/hearing treatment (CPT® 92507)
    • Regarding speech generating devices (SGDs), use CPT® 92607 for selection and prescription; use CPT® 92609 for adaptation and training.
  • Note: Current Procedural Terminology (CPT®) does not define a re-evaluation code for Speech-Language Pathology: use the evaluation code.

Glossary of terms commonly used in Speech Language Pathology

Amelioration – to make or become better.

Articulation – vocal tract movements for speech sound production; involves accuracy in placement of the articulators, timing, direction of movements, force extended, speed or response, and neutral integration of all events.

Audition – the sense or act of hearing.

Compensation - to make up for or offset; counterbalance; making up for a deficiency or loss.

Fluency – smoothness with which sounds, syllables, words and phrases are joined together during oral language; lack of hesitations or repetitions in speaking.

Morphology – study of how morphemes (smallest meaningful unit of a language) are put together to form words; indicates how words are formed and provides a bridge between phonology and syntax.

Phonology – study of the sound system of a language, including pauses and stress.

Pragmatics – study of the rules underlying the functional use of language.

Resonance - sympathetic or forced vibration of the air in the cavities above, below, in front of, or behind the source of a sound.

Semantics – 1) study of meaning in language which includes the relation between language, thoughts, and behavior; 2) study of meaning of speech forms, especially of the development and changes in meaning of words and word groups; 3) study of the development of the meaning of words, its goals is to account for the knowledge a native speaker has which enables him to judge some sentences as meaningful, some as ambiguous, and some as anomalous.

Syntax – 1) the internal structure of language including the order in which the element of a language can occur and the relationships among the elements in an utterance; 2) rules that dictate the acceptable sequences, combination, and function of words in a sentence; 3) the way in which words are put together in a sentence to convey meaning.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
032x Home Health Services under a plan of treatment
N/A

Revenue Codes

Code Description
0440 Speech-Language Pathology - General Classification
0441 Speech-Language Pathology - Visit
0444 Speech-Language Pathology - Evaluation or Reevaluation
N/A

CPT/HCPCS Codes

Group 1

(38 Codes)
Group 1 Paragraph

Note: CPT/HCPCS code G0153 must be used by Home Health agencies billing a 32x bill type. G0153 code is used to report 15-minute increments. All other CPT/HCPCS codes listed in this article are for informational and descriptive use only.

Group 1 Codes
Code Description
92507 Speech/hearing therapy
92517 Vemp test i&r cervical
92518 Vemp test i&r ocular
92519 Vemp tst i&r cervical&ocular
92521 Evaluation of speech fluency
92522 Evaluate speech production
92523 Speech sound lang comprehen
92524 Behavral qualit analys voice
92526 Oral function therapy
92597 Oral speech device eval
92607 Ex for speech device rx 1hr
92608 Ex for speech device rx addl
92609 Use of speech device service
92610 Evaluate swallowing function
92626 Eval aud funcj 1st hour
92627 Eval aud funcj ea addl 15
92630 Aud rehab pre-ling hear loss
92633 Aud rehab postling hear loss
92650 Aep scr auditory potential
92651 Aep hearing status deter i&r
92652 Aep thrshld est mlt freq i&r
92653 Aep neurodiagnostic i&r
96105 Assessment of aphasia
96112 Devel tst phys/qhp 1st hr
96113 Devel tst phys/qhp ea addl
96116 Nubhvl xm phys/qhp 1st hr
96121 Nubhvl xm phy/qhp ea addl hr
96125 Cognitive test by hc pro
97110 Therapeutic exercises
97129 Ther ivntj 1st 15 min
97130 Ther ivntj ea addl 15 min
97530 Therapeutic activities
97533 Sensory integration
97535 Self care mngment training
97550 Caregiver traing 1st 30 min
97551 Caregiver traing ea addl 15
G0153 Hhcp-svs of s/l path,ea 15mn
G0161 Hhc slp ea 15 min
N/A

CPT/HCPCS Modifiers

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(215 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
F01.518 Vascular dementia, unspecified severity, with other behavioral disturbance
F01.A18 Vascular dementia, mild, with other behavioral disturbance
F01.B18 Vascular dementia, moderate, with other behavioral disturbance
F01.C18 Vascular dementia, severe, with other behavioral disturbance
F02.818 Dementia in other diseases classified elsewhere, unspecified severity, with other behavioral disturbance
F02.A18 Dementia in other diseases classified elsewhere, mild, with other behavioral disturbance
F02.B18 Dementia in other diseases classified elsewhere, moderate, with other behavioral disturbance
F02.C18 Dementia in other diseases classified elsewhere, severe, with other behavioral disturbance
F80.1 Expressive language disorder
F80.2 Mixed receptive-expressive language disorder
F80.4 Speech and language development delay due to hearing loss
F80.81 Childhood onset fluency disorder
F80.82 Social pragmatic communication disorder
F81.0 Specific reading disorder
F81.81 Disorder of written expression
F82 Specific developmental disorder of motor function
F88 Other disorders of psychological development
F95.2 Tourette's disorder
F98.29 Other feeding disorders of infancy and early childhood
F98.5 Adult onset fluency disorder
G30.0 Alzheimer's disease with early onset
G30.1 Alzheimer's disease with late onset
G30.8 Other Alzheimer's disease
G30.9 Alzheimer's disease, unspecified
G31.80 Leukodystrophy, unspecified
G31.85 Corticobasal degeneration
G31.86 Alexander disease
G36.0 Neuromyelitis optica [Devic]
G36.1 Acute and subacute hemorrhagic leukoencephalitis [Hurst]
G36.8 Other specified acute disseminated demyelination
G36.9 Acute disseminated demyelination, unspecified
G37.0 Diffuse sclerosis of central nervous system
G37.1 Central demyelination of corpus callosum
G37.2 Central pontine myelinolysis
G37.4 Subacute necrotizing myelitis of central nervous system
G37.5 Concentric sclerosis [Balo] of central nervous system
G37.9 Demyelinating disease of central nervous system, unspecified
G70.81 Lambert-Eaton syndrome in disease classified elsewhere
G71.11 Myotonic muscular dystrophy
G71.12 Myotonia congenita
G71.13 Myotonic chondrodystrophy
G71.14 Drug induced myotonia
G71.19 Other specified myotonic disorders
G71.20 Congenital myopathy, unspecified
G71.21 Nemaline myopathy
G71.220 X-linked myotubular myopathy
G71.228 Other centronuclear myopathy
G71.29 Other congenital myopathy
G72.0 Drug-induced myopathy
G72.1 Alcoholic myopathy
G72.2 Myopathy due to other toxic agents
G72.3 Periodic paralysis
G73.1 Lambert-Eaton syndrome in neoplastic disease
G80.0 Spastic quadriplegic cerebral palsy
G80.1 Spastic diplegic cerebral palsy
G80.2 Spastic hemiplegic cerebral palsy
G80.3 Athetoid cerebral palsy
G80.4 Ataxic cerebral palsy
G80.8 Other cerebral palsy
G80.9 Cerebral palsy, unspecified
H90.0 Conductive hearing loss, bilateral
H90.11 Conductive hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.12 Conductive hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.3 Sensorineural hearing loss, bilateral
H90.41 Sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.42 Sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.6 Mixed conductive and sensorineural hearing loss, bilateral
H90.71 Mixed conductive and sensorineural hearing loss, unilateral, right ear, with unrestricted hearing on the contralateral side
H90.72 Mixed conductive and sensorineural hearing loss, unilateral, left ear, with unrestricted hearing on the contralateral side
H90.A11 Conductive hearing loss, unilateral, right ear with restricted hearing on the contralateral side
H90.A12 Conductive hearing loss, unilateral, left ear with restricted hearing on the contralateral side
H90.A21 Sensorineural hearing loss, unilateral, right ear, with restricted hearing on the contralateral side
H90.A22 Sensorineural hearing loss, unilateral, left ear, with restricted hearing on the contralateral side
H90.A31 Mixed conductive and sensorineural hearing loss, unilateral, right ear with restricted hearing on the contralateral side
H90.A32 Mixed conductive and sensorineural hearing loss, unilateral, left ear with restricted hearing on the contralateral side
H91.3 Deaf nonspeaking, not elsewhere classified
H93.221 Diplacusis, right ear
H93.222 Diplacusis, left ear
H93.223 Diplacusis, bilateral
H93.241 Temporary auditory threshold shift, right ear
H93.242 Temporary auditory threshold shift, left ear
H93.243 Temporary auditory threshold shift, bilateral
H93.25 Central auditory processing disorder
H93.291 Other abnormal auditory perceptions, right ear
H93.292 Other abnormal auditory perceptions, left ear
H93.293 Other abnormal auditory perceptions, bilateral
I69.010 Attention and concentration deficit following nontraumatic subarachnoid hemorrhage
I69.012 Visuospatial deficit and spatial neglect following nontraumatic subarachnoid hemorrhage
I69.013 Psychomotor deficit following nontraumatic subarachnoid hemorrhage
I69.014 Frontal lobe and executive function deficit following nontraumatic subarachnoid hemorrhage
I69.015 Cognitive social or emotional deficit following nontraumatic subarachnoid hemorrhage
I69.018 Other symptoms and signs involving cognitive functions following nontraumatic subarachnoid hemorrhage
I69.019 Unspecified symptoms and signs involving cognitive functions following nontraumatic subarachnoid hemorrhage
I69.020 Aphasia following nontraumatic subarachnoid hemorrhage
I69.021 Dysphasia following nontraumatic subarachnoid hemorrhage
I69.022 Dysarthria following nontraumatic subarachnoid hemorrhage
I69.023 Fluency disorder following nontraumatic subarachnoid hemorrhage
I69.028 Other speech and language deficits following nontraumatic subarachnoid hemorrhage
I69.090 Apraxia following nontraumatic subarachnoid hemorrhage
I69.091 Dysphagia following nontraumatic subarachnoid hemorrhage
I69.092 Facial weakness following nontraumatic subarachnoid hemorrhage
I69.110 Attention and concentration deficit following nontraumatic intracerebral hemorrhage
I69.112 Visuospatial deficit and spatial neglect following nontraumatic intracerebral hemorrhage
I69.114 Frontal lobe and executive function deficit following nontraumatic intracerebral hemorrhage
I69.115 Cognitive social or emotional deficit following nontraumatic intracerebral hemorrhage
I69.118 Other symptoms and signs involving cognitive functions following nontraumatic intracerebral hemorrhage
I69.120 Aphasia following nontraumatic intracerebral hemorrhage
I69.121 Dysphasia following nontraumatic intracerebral hemorrhage
I69.122 Dysarthria following nontraumatic intracerebral hemorrhage
I69.123 Fluency disorder following nontraumatic intracerebral hemorrhage
I69.128 Other speech and language deficits following nontraumatic intracerebral hemorrhage
I69.190 Apraxia following nontraumatic intracerebral hemorrhage
I69.191 Dysphagia following nontraumatic intracerebral hemorrhage
I69.192 Facial weakness following nontraumatic intracerebral hemorrhage
I69.210 Attention and concentration deficit following other nontraumatic intracranial hemorrhage
I69.212 Visuospatial deficit and spatial neglect following other nontraumatic intracranial hemorrhage
I69.214 Frontal lobe and executive function deficit following other nontraumatic intracranial hemorrhage
I69.215 Cognitive social or emotional deficit following other nontraumatic intracranial hemorrhage
I69.220 Aphasia following other nontraumatic intracranial hemorrhage
I69.221 Dysphasia following other nontraumatic intracranial hemorrhage
I69.222 Dysarthria following other nontraumatic intracranial hemorrhage
I69.223 Fluency disorder following other nontraumatic intracranial hemorrhage
I69.228 Other speech and language deficits following other nontraumatic intracranial hemorrhage
I69.290 Apraxia following other nontraumatic intracranial hemorrhage
I69.291 Dysphagia following other nontraumatic intracranial hemorrhage
I69.292 Facial weakness following other nontraumatic intracranial hemorrhage
I69.310 Attention and concentration deficit following cerebral infarction
I69.312 Visuospatial deficit and spatial neglect following cerebral infarction
I69.313 Psychomotor deficit following cerebral infarction
I69.314 Frontal lobe and executive function deficit following cerebral infarction
I69.315 Cognitive social or emotional deficit following cerebral infarction
I69.320 Aphasia following cerebral infarction
I69.321 Dysphasia following cerebral infarction
I69.322 Dysarthria following cerebral infarction
I69.323 Fluency disorder following cerebral infarction
I69.328 Other speech and language deficits following cerebral infarction
I69.390 Apraxia following cerebral infarction
I69.391 Dysphagia following cerebral infarction
I69.392 Facial weakness following cerebral infarction
I69.810 Attention and concentration deficit following other cerebrovascular disease
I69.812 Visuospatial deficit and spatial neglect following other cerebrovascular disease
I69.813 Psychomotor deficit following other cerebrovascular disease
I69.814 Frontal lobe and executive function deficit following other cerebrovascular disease
I69.815 Cognitive social or emotional deficit following other cerebrovascular disease
I69.820 Aphasia following other cerebrovascular disease
I69.821 Dysphasia following other cerebrovascular disease
I69.822 Dysarthria following other cerebrovascular disease
I69.823 Fluency disorder following other cerebrovascular disease
I69.828 Other speech and language deficits following other cerebrovascular disease
I69.890 Apraxia following other cerebrovascular disease
I69.891 Dysphagia following other cerebrovascular disease
I69.892 Facial weakness following other cerebrovascular disease
I69.910 Attention and concentration deficit following unspecified cerebrovascular disease
I69.912 Visuospatial deficit and spatial neglect following unspecified cerebrovascular disease
I69.913 Psychomotor deficit following unspecified cerebrovascular disease
I69.914 Frontal lobe and executive function deficit following unspecified cerebrovascular disease
I69.915 Cognitive social or emotional deficit following unspecified cerebrovascular disease
I69.920 Aphasia following unspecified cerebrovascular disease
I69.921 Dysphasia following unspecified cerebrovascular disease
I69.922 Dysarthria following unspecified cerebrovascular disease
I69.923 Fluency disorder following unspecified cerebrovascular disease
I69.928 Other speech and language deficits following unspecified cerebrovascular disease
I69.990 Apraxia following unspecified cerebrovascular disease
I69.991 Dysphagia following unspecified cerebrovascular disease
I69.992 Facial weakness following unspecified cerebrovascular disease
J38.01 Paralysis of vocal cords and larynx, unilateral
J38.02 Paralysis of vocal cords and larynx, bilateral
J38.2 Nodules of vocal cords
J38.3 Other diseases of vocal cords
K14.8 Other diseases of tongue
M26.211 Malocclusion, Angle's class I
M26.212 Malocclusion, Angle's class II
M26.213 Malocclusion, Angle's class III
M26.220 Open anterior occlusal relationship
M26.221 Open posterior occlusal relationship
M26.23 Excessive horizontal overlap
M26.24 Reverse articulation
M26.25 Anomalies of interarch distance
M26.29 Other anomalies of dental arch relationship
Q38.1 Ankyloglossia
Q38.2 Macroglossia
Q38.3 Other congenital malformations of tongue
R05.8 Other specified cough
R06.1 Stridor
R06.89 Other abnormalities of breathing
R13.0 Aphagia
R13.10 Dysphagia, unspecified
R13.11 Dysphagia, oral phase
R13.12 Dysphagia, oropharyngeal phase
R13.13 Dysphagia, pharyngeal phase
R13.14 Dysphagia, pharyngoesophageal phase
R13.19 Other dysphagia
R41.4 Neurologic neglect syndrome
R41.841 Cognitive communication deficit
R47.01 Aphasia
R47.02 Dysphasia
R47.1 Dysarthria and anarthria
R47.81 Slurred speech
R47.82 Fluency disorder in conditions classified elsewhere
R47.89 Other speech disturbances
R48.0 Dyslexia and alexia
R48.1 Agnosia
R48.2 Apraxia
R48.8 Other symbolic dysfunctions
R49.0 Dysphonia
R49.1 Aphonia
R49.21 Hypernasality
R49.22 Hyponasality
R49.8 Other voice and resonance disorders
R62.0 Delayed milestone in childhood
R63.39 Other feeding difficulties
R68.89 Other general symptoms and signs
Z43.0 Encounter for attention to tracheostomy
Z44.8 Encounter for fitting and adjustment of other external prosthetic devices
Z96.3 Presence of artificial larynx
N/A

ICD-10-CM Codes that DO NOT Support Medical Necessity

Group 1

Group 1 Paragraph

Any ICD-10 codes not listed in the ICD-10-CM Codes that Support Medical Necessity section of this article may be subject to medical review.

Group 1 Codes

N/A

N/A

ICD-10-PCS Codes

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Additional ICD-10 Information

N/A

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

Code Description
032x Home Health Services under a plan of treatment
N/A

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

Code Description
0440 Speech-Language Pathology - General Classification
0441 Speech-Language Pathology - Visit
0444 Speech-Language Pathology - Evaluation or Reevaluation
N/A

Other Coding Information

Group 1

Group 1 Paragraph

N/A

Group 1 Codes

N/A

N/A

Coding Table Information

Excluded CPT/HCPCS Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A N/A
N/A
Non-Excluded CPT/HCPCS Ended Codes - Table Format
Code Descriptor Generic Name Descriptor Brand Name Exclusion Effective Date Exclusion End Date Reason for Exclusion
N/A

Revision History Information

Revision History Date Revision History Number Revision History Explanation
01/01/2024 R17

Under CPT/HCPCS Codes Group 1: Codes added 97550 and 97551. This revision is due to the 2024 Annual/Q1 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/24.

10/01/2023 R16

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted G37.8 and added G31.80 and G31.86. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/01/23.

10/01/2022 R15

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted F02.81, F03.91 and added F01.518, F01.A18, F01.B18, F01.C18, F02.818, F02.A18, F02.B18, F02.C18. This revision is due to the Annual ICD-10-CM Update and will become effective on 10/1/22.

05/26/2022 R14

Under CMS National Coverage Policy deleted the regulation “CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Change Request 10308, Transmittal 3877, dated October 6, 2017” and added the following regulations: Title XVIII of the Social Security Act, §1833(e) prohibits Medicare payment for any claim lacking the necessary documentation to process the claim and Title XVIII of the Social Security Act, §1835(a)(2)(A) Procedure for payment of claims of providers of services. Under Article Text revised the verbiage under subheading Coding Guidelines #2. to state “For the purpose of the related LCD”.

10/01/2021 R13

Under CMS National Coverage Policy updated section headings for regulations. Under ICD-10-CM Codes that DO NOT Support Medical Necessity Group 1: Paragraph updated section heading for “ICD-10-CM Codes that Support Medical Necessity”. This revision will become effective 10/1/21.

Under ICD-10-CM Codes that Support Medical Necessity Group 1: Codes deleted R05 and R63.3, added R05.8 and R63.39, and the description was revised for G71.20. This revision is due to the Annual ICD-10 Update and will become effective on 10/1/21.

01/01/2021 R12

Under CPT/HCPCS Codes Group 1: Codes added 92517, 92518, 92519, 92650, 92651, 92652 and 92653. This revision is due to the Q1 2021 CPT/HCPCS Code Update and is retroactive effective for dates of service on or after 1/1/2021.

10/01/2020 R11

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added G71.20, G71.21, G71.220, G71.228 and G71.29. This revision is due to the Annual ICD-10 Code Update and is effective on October 1, 2020.

01/01/2020 R10

Under CPT/HCPCS Codes Group 1: Codes CPT® codes 97129 and 97130 were added, G0515 was deleted, and the description changed for 92626 and 92627. This revision is due to the 2020 Annual CPT/HCPCS Code Update and is effective on January 1, 2020.

11/07/2019 R9

This article is being revised in order to adhere to CMS requirements per chapter 13, section 13.5.1 of the Program Integrity Manual, to remove all coding from LCDs and incorporate into related Billing and Coding Articles. Regulations regarding billing and coding were removed from the CMS National Coverage Policy section of the related Home Health Speech-Language Pathology L34563 LCD and placed in this article. Under ICD-10 Codes that DO NOT Support Medical Necessity Group 1: Paragraph updated section heading. The above revisions are effective on 11/7/2019.

Under ICD-10 Codes that Support Medical Necessity Group 1: Codes added ICD-10 code R68.89. The addition of this code is retroactive effective for dates of service on or after 10/1/2015.

08/15/2019 R8

All coding located in the Coding Information section has been removed from the related Home Health Speech-Language Pathology L34563 LCD and added to this article.

Under Article Title changed the title from “Coding Guidelines for Home Health Speech-Language Pathology” to “Billing and Coding: Home Health Speech-Language Pathology”. Under Article Text added the sentence “The information in this article contains billing, coding or other guidelines that complement the Local Coverage Determination (LCD) for Home Health Speech-Language Pathology L34563” to the first paragraph. Added the subheading Re-evaluation and corresponding verbiage. Under CPT/HCPCS Codes Group 1: Paragraph added the verbiage “Note: CPT/HCPCS code G0153 must be used by Home Health agencies billing a 32x bill type. G0153 code is used to report 15-minute increments. All other CPT/HCPCS codes listed in this Billing and Coding: Home Health Speech-Language Pathology A53052 article are for informational and descriptive use only”. Under Non-Covered ICD-10 Codes Group 1: Paragraph added the verbiage “Any ICD-10 codes not listed in the Covered ICD-10 Codes section of this Billing and Coding: Home Health Speech-Language Pathology A53052 article may be subject to medical review”. Formatting, punctuation and typographical errors were corrected throughout the article. Acronyms were inserted and defined where appropriate throughout the article.

01/01/2019 R7

Under CPT/HCPCS Codes Group 1: Codes, CPT code 96111 has been deleted. Under CPT/HCPCS Codes Group 1: Codes, the following CPT codes have been added: 96112, 96113 and 96121. Under CPT/HCPCS Codes Group 1: Codes the code description was revised for CPT code 96116. This revision is due to the Annual CPT/HCPCS Code Update.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.

 

01/01/2018 R6

Under CPT/HCPCS Codes Group 1 deleted CPT code 97532. This revision is due to the Annual CPT/HCPCS Code Update.

At this time 21st Century Cures Act will apply to new and revised LCDs that restrict coverage which requires comment and notice. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy.


 

 

 

10/01/2016 R5 Under CPT/HCPCS Codes added G0161 and CPT 92597. Under Covered ICD-10 Codes added G80.0, G80.1, G80.2, G80.3, G80.4, G80.8, G80.9, R13.10, and Z96.3 to be consistent with the LCD. Under Covered ICD-10 Codes added F80.82, H90.A11, H90.A12, H90.A21, H90.A22, H90.A31, H90.A32, I69.010, I69.012, I69.013, I69.014, I69.015, I69.018, I69.019, I69.110, I69.112, I69.114, I69.115, I69.118, I69.210, I69.212, I69.214, I69.215, I69.310, I69.312, I69.313, I69.314, I69.315, I69.810, I69.812, I69.813, I69.814, I69.815, I69.910, I69.912, I69.913, I69.914, and I69.915 due to the Annual ICD-10 Code Update.
02/04/2016 R4 Under Article Text added "of terms commonly used in Speech Language Pathology" to the definition of Glossary; added "(smallest meaningful unit of a language)" to the definition of Morphology.
06/25/2015 R3 A descriptor changes was made to the Bill Type codes due to the May NUBC updates.
10/01/2015 R2 Under Bill Type Codes removed 033x Bill Type. Under Revenue Codes clarified 044x into 0440, 0441, 0444. Under CPT/HCPCS Codes added all CPT codes from policy. Under Covered ICD-10 Codes added all ICD-10 codes from policy.
10/01/2015 R1 In Covered ICD-10 Codes added R68.89. In CPT/HCPCS Codes added G0153.

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Associated Documents

Medicare BPM Ch 15.50.2 SAD Determinations
Medicare BPM Ch 15.50.2
Related Local Coverage Documents
LCDs
L34563 - Home Health Speech-Language Pathology
Related National Coverage Documents
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SAD Process URL 1
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SAD Process URL 2
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
01/12/2024 01/01/2024 - N/A Currently in Effect You are here
09/13/2023 10/01/2023 - 12/31/2023 Superseded View
08/22/2022 10/01/2022 - 09/30/2023 Superseded View
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Keywords

  • Home Health
  • Speech Language Pathology
  • SLP