SUPERSEDED LCD Reference Article Billing and Coding Article

Billing and Coding: Speech-Language Pathology

A57040

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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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Note History

Contractor Information

Article Information

General Information

Source Article ID
N/A
Article ID
A57040
Original ICD-9 Article ID
Not Applicable
Article Title
Billing and Coding: Speech-Language Pathology
Article Type
Billing and Coding
Original Effective Date
09/26/2019
Revision Effective Date
10/01/2023
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2023 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

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

Language quoted from Centers for Medicare and Medicaid Services (CMS), National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals is italicized throughout the policy. NCDs and coverage provisions in interpretive manuals are not subject to the Local Coverage Determination (LCD) Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See Section 1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources:

Title XVIII of the Social Security Act (SSA):

Section 1833(e) of Title XVIII of the Social Security Act prohibits Medicare payment for any claim which lacks the necessary information to process the claim.

Section 1835(2)(D) of Title XVIII of the Social Security Act lists requirements for certification and recertification of outpatient speech-language pathology services.

Section 1862(a)(1)(A) of Title XVIII of the Social Security Act excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.

Section 1862(a)(7) excludes routine physical examinations, unless otherwise covered by statute.

Code of Federal Regulations:

42 CFR, Section 410.61 describes plan of treatment requirements.

42 CFR, Section 410.62 describes outpatient speech-language pathology services: Conditions and exclusions for Outpatient Speech Language Pathology (SLP).

42 CFR, Section 485.705 describes personnel qualifications.

CMS Publications:

CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 12:

    40.4 Speech-language pathology services

CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15:

    220 Coverage of outpatient rehabilitation therapy services (physical therapy, occupational therapy, and speech-language pathology services) under medical insurance
    220.1 Conditions of coverage and payment for outpatient physical therapy, occupational therapy, or speech-language pathology services
    220.1.1 Outpatient therapy must be under the care of a physician/nonphysician practitioners (NPP) (orders/referrals and need for care)
    220.1.3 Certification and recertification of need for treatment and therapy plans of care
    220.1.4 Requirement that services be furnished on an outpatient basis
    230.3 Practice of speech-language pathology
    230.6 Therapy services furnished under arrangements with providers and clinics

CMS Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Part 1:

    50.2 Electronic speech aids

CMS Pub. 100-03, Medicare National Coverage Determinations (NCD) Manual, Part 3:

    170.2 Melodic intonation therapy

CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 5:

    10.2 Financial limitation
    20 HCPCS coding requirement

CMS Pub. 100-04, Medicare Claims Processing Manual, Chapter 6,

    10.3 Types of services subject to the consolidated billing requirement for SNFs

CMS Transmittal No. 111, Publication 100-02, Medicare Benefit Policy Manual, Change Request #6005, September 25, 2009, advises that speech-language pathology therapy services are covered CORF services if physical therapy services are the predominate rehabilitation services.

CMS Transmittal No. 106, Publication 100-02, Medicare Benefit Policy Manual, Change Request #6381, April 24, 2009, advises that enrolled speech-language pathologists may bill for services provided on or after July 1, 2009.

CMS Transmittal No. 1717, Publication 100-04, Medicare Claims Processing Manual, Change Request #6381, April 24, 2009, advises that enrolled speech-language pathologists may bill for services provided on or after July 1, 2009.

CMS Transmittal No. 88, Publication 100-02, Medicare Benefit Policy Manual, Change Request #5921, May 7, 2008, Therapy Personnel Qualifications and Policies Effective January 1, 2008.

Article Guidance

Article Text

This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy Speech-Language Pathology.

General Guidelines for Claims submitted to Part A or Part B MAC:

Procedure codes may be subject to National Correct Coding Initiative (NCCI) edits or OPPS packaging edits. Refer to NCCI and OPPS requirements prior to billing Medicare. For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim. A claim submitted without a valid ICD-10-CM diagnosis code will be returned to the provider as an incomplete claim under Section 1833(e) of the Social Security Act. The diagnosis code(s) must best describe the patient's condition for which the service was performed. For diagnostic tests, report the result of the test if known; otherwise the symptoms prompting the performance of the test should be reported.

Advance Beneficiary Notice of Non-coverage (ABN) Modifier Guidelines

An ABN may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.

Effective from April 1, 2010, non-covered services should be billed with modifier –GA, -GX, -GY, or –GZ, as appropriate.

The –GA modifier (“Waiver of Liability Statement Issued as Required by Payer Policy”) should be used when physicians, practitioners, or suppliers want to indicate that they anticipate that Medicare will deny a specific service as not reasonable and necessary and they do have an ABN signed by the beneficiary on file. Modifier GA applies only when services will be denied under reasonable and necessary provisions, sections 1862(a)(1), 1862(a)(9), 1879(e), or 1879(g) of the Social Security Act. Effective April 1, 2010, Part A MAC systems will automatically deny services billed with modifier GA. An ABN, Form CMS-R-131, should be signed by the beneficiary to indicate that ‎he/she accepts responsibility for payment.‎ The -GA modifier may also be used on assigned claims when a patient refuses to sign the ABN and the latter is properly witnessed. For claims submitted to the Part A MAC, occurrence code 32 and the date of the ABN is required.

 

Modifier GX (“Notice of Liability Issued, Voluntary Under Payer Policy”) should be used when the beneficiary has signed an ABN, and a denial is anticipated based on provisions other than medical necessity, such as statutory exclusions of coverage or technical issues. An ABN is not required for these denials, but if non-covered services are reported with modifier GX, will automatically be denied services.

 

The –GZ modifier should be used when physicians, practitioners, or suppliers want to indicate that they expect that Medicare will deny an item or service as not reasonable and necessary and they have not had an ABN signed by the beneficiary. ‎If the service is statutorily non-covered, or without a benefit category, submit the ‎appropriate CPT/HCPCS code with the -GY modifier. An ABN is not required for these denials, and the limitation of liability does not apply for beneficiaries. Services with modifier GY will automatically deny.

Documentation Requirements

The patient’s medical record should include but is not limited to:

  • The assessment of the patient by the ordering provider as it relates to the complaint of the patient for that visit,
  • Relevant medical history
  • Results of pertinent tests/procedures
  • Signed and dated office visit record/operative report (Please note that all services ordered or rendered to Medicare beneficiaries must be signed.)

 

The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. (See "Indications and Limitations of Coverage.") This documentation includes, but is not limited to, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures. Not only should documentation describe the condition of the patient that necessitates the skilled intervention of the speech-language pathologist, but should also report clinical judgment and describe the skilled nature of the treatment. Documenting the skilled components of activities will assist in supporting that the services are medically necessary.

Documentation of speech language services, like other therapy services, must be objective, clear, concise, and must show evidence of the beneficiary's progress in meeting treatment goals. Documentation in the clinical record must be descriptive, clearly related to functionality, and complement and correlate with other disciplines. Medical necessity may not be established if there is conflicting documentation between disciplines or widely fluctuating abilities indicating an unstable condition. Prior level of functioning must be documented and considered in the patient's treatment plan, to establish reasonable goals for the patient's present condition. Statements such as "mildly impaired to moderately impaired" or "fair plus to good minus" do not offer sufficient objective and measurable information to support progress and may result in denial of services as not medically necessary. Documentation of discharge planning should be indicated early in the treatment plan.

Where a valid expectation of improvement existed at the time services were initiated, or thereafter, the services may be covered even though the expectation may not be realized. Progress reports must document a continued reasonable expectation that the patient's condition will improve significantly, i.e., a measurable and substantial increase in the patient's level of communication, independence, and functional competence compared to the level when treatment was initiated. Documentation should include improvements, setbacks, and intervening medical complications—whatever is deemed pertinent to justify the need for continued intervention.

For additional information on Medicare documentation requirements for speech-language pathology services see: CMS Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section, 220, including the subsections under Section 220.

Response To Comments

Number Comment Response
1
N/A

Coding Information

Bill Type Codes

Code Description
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
018x Hospital - Swing Beds
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
034x Home Health Services not under a plan of treatment
071x Clinic - Rural Health
074x Clinic - Outpatient Rehabilitation Facility (ORF)
075x Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
N/A

Revenue Codes

Code Description
0440 Speech-Language Pathology - General Classification
0444 Speech-Language Pathology - Evaluation or Reevaluation
0449 Speech-Language Pathology - Other Speech Therapy
N/A

CPT/HCPCS Codes

Group 1

(21 Codes)
Group 1 Paragraph

N/A

Group 1 Codes
Code Description
31579 LARYNGOSCOPY, FLEXIBLE OR RIGID TELESCOPIC, WITH STROBOSCOPY
92507 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; INDIVIDUAL
92508 TREATMENT OF SPEECH, LANGUAGE, VOICE, COMMUNICATION, AND/OR AUDITORY PROCESSING DISORDER; GROUP, 2 OR MORE INDIVIDUALS
92521 EVALUATION OF SPEECH FLUENCY (EG, STUTTERING, CLUTTERING)
92522 EVALUATION OF SPEECH SOUND PRODUCTION (EG, ARTICULATION, PHONOLOGICAL PROCESS, APRAXIA, DYSARTHRIA);
92523 EVALUATION OF SPEECH SOUND PRODUCTION (EG, ARTICULATION, PHONOLOGICAL PROCESS, APRAXIA, DYSARTHRIA); WITH EVALUATION OF LANGUAGE COMPREHENSION AND EXPRESSION (EG, 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
92607 EVALUATION FOR PRESCRIPTION FOR SPEECH-GENERATING AUGMENTATIVE AND ALTERNATIVE COMMUNICATION DEVICE, FACE-TO-FACE WITH THE PATIENT; FIRST HOUR
92608 EVALUATION FOR PRESCRIPTION FOR SPEECH-GENERATING AUGMENTATIVE AND ALTERNATIVE COMMUNICATION DEVICE, FACE-TO-FACE WITH THE PATIENT; EACH ADDITIONAL 30 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
92609 THERAPEUTIC SERVICES FOR THE USE OF SPEECH-GENERATING DEVICE, INCLUDING PROGRAMMING AND MODIFICATION
92626 EVALUATION OF AUDITORY FUNCTION FOR SURGICALLY IMPLANTED DEVICE(S) CANDIDACY OR POSTOPERATIVE STATUS OF A SURGICALLY IMPLANTED DEVICE(S); FIRST HOUR
92627 EVALUATION OF AUDITORY FUNCTION FOR SURGICALLY IMPLANTED DEVICE(S) CANDIDACY OR POSTOPERATIVE STATUS OF A SURGICALLY IMPLANTED DEVICE(S); EACH ADDITIONAL 15 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
96105 ASSESSMENT OF APHASIA (INCLUDES ASSESSMENT OF EXPRESSIVE AND RECEPTIVE SPEECH AND LANGUAGE FUNCTION, LANGUAGE COMPREHENSION, SPEECH PRODUCTION ABILITY, READING, SPELLING, WRITING, EG, BY BOSTON DIAGNOSTIC APHASIA EXAMINATION) WITH INTERPRETATION AND REPORT, PER HOUR
96110 DEVELOPMENTAL SCREENING (EG, DEVELOPMENTAL MILESTONE SURVEY, SPEECH AND LANGUAGE DELAY SCREEN), WITH SCORING AND DOCUMENTATION, PER STANDARDIZED INSTRUMENT
96112 DEVELOPMENTAL TEST ADMINISTRATION (INCLUDING ASSESSMENT OF FINE AND/OR GROSS MOTOR, LANGUAGE, COGNITIVE LEVEL, SOCIAL, MEMORY AND/OR EXECUTIVE FUNCTIONS BY STANDARDIZED DEVELOPMENTAL INSTRUMENTS WHEN PERFORMED), BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, WITH INTERPRETATION AND REPORT; FIRST HOUR
96113 DEVELOPMENTAL TEST ADMINISTRATION (INCLUDING ASSESSMENT OF FINE AND/OR GROSS MOTOR, LANGUAGE, COGNITIVE LEVEL, SOCIAL, MEMORY AND/OR EXECUTIVE FUNCTIONS BY STANDARDIZED DEVELOPMENTAL INSTRUMENTS WHEN PERFORMED), BY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, WITH INTERPRETATION AND REPORT; EACH ADDITIONAL 30 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
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 TEST RESULTS AND PREPARING THE REPORT
97129 THERAPEUTIC INTERVENTIONS THAT FOCUS ON COGNITIVE FUNCTION (EG, ATTENTION, MEMORY, REASONING, EXECUTIVE FUNCTION, PROBLEM SOLVING, AND/OR PRAGMATIC FUNCTIONING) AND COMPENSATORY STRATEGIES TO MANAGE THE PERFORMANCE OF AN ACTIVITY (EG, MANAGING TIME OR SCHEDULES, INITIATING, ORGANIZING, AND SEQUENCING TASKS), DIRECT (ONE-ON-ONE) PATIENT CONTACT; INITIAL 15 MINUTES
97130 THERAPEUTIC INTERVENTIONS THAT FOCUS ON COGNITIVE FUNCTION (EG, ATTENTION, MEMORY, REASONING, EXECUTIVE FUNCTION, PROBLEM SOLVING, AND/OR PRAGMATIC FUNCTIONING) AND COMPENSATORY STRATEGIES TO MANAGE THE PERFORMANCE OF AN ACTIVITY (EG, MANAGING TIME OR SCHEDULES, INITIATING, ORGANIZING, AND SEQUENCING TASKS), DIRECT (ONE-ON-ONE) PATIENT CONTACT; EACH ADDITIONAL 15 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
97533 SENSORY INTEGRATIVE TECHNIQUES TO ENHANCE SENSORY PROCESSING AND PROMOTE ADAPTIVE RESPONSES TO ENVIRONMENTAL DEMANDS, DIRECT (ONE-ON-ONE) PATIENT CONTACT, EACH 15 MINUTES
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

(141 Codes)
Group 1 Paragraph

It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

Note: ICD-10-CM code Z01.818 should be reported for pre-laryngectomy examinations

Group 1 Codes
Code Description
F80.0 - F80.2 Phonological disorder - Mixed receptive-expressive language disorder
F80.4 Speech and language development delay due to hearing loss
F80.81 Childhood onset fluency disorder
F80.89 Other developmental disorders of speech and language
F81.0 Specific reading disorder
F81.2 Mathematics disorder
F81.81 Disorder of written expression
F81.89 Other developmental disorders of scholastic skills
F82 Specific developmental disorder of motor function
F88 Other disorders of psychological development
F90.2 Attention-deficit hyperactivity disorder, combined type
F98.5 Adult onset fluency disorder
G52.1 - G52.3 Disorders of glossopharyngeal nerve - Disorders of hypoglossal nerve
G52.7 Disorders of multiple cranial nerves
G52.8 Disorders of other specified cranial nerves
G60.8 Other hereditary and idiopathic neuropathies
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
H90.2 Conductive hearing loss, unspecified
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
H90.5 Unspecified sensorineural hearing loss
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
H90.8 Mixed conductive and sensorineural hearing loss, unspecified
H93.25 Central auditory processing disorder
H93.91 - H93.93 Unspecified disorder of right ear - Unspecified disorder of ear, bilateral
I69.010 Attention and concentration deficit following nontraumatic subarachnoid hemorrhage
I69.011 Memory 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
I69.020 - I69.023 Aphasia following nontraumatic subarachnoid hemorrhage - Fluency disorder following nontraumatic subarachnoid hemorrhage
I69.028 Other speech and language deficits following nontraumatic subarachnoid hemorrhage
I69.092 Facial weakness following nontraumatic subarachnoid hemorrhage
I69.111 Memory deficit following nontraumatic intracerebral hemorrhage
I69.112 Visuospatial deficit and spatial neglect following nontraumatic intracerebral hemorrhage
I69.113 Psychomotor deficit 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 - I69.123 Aphasia following nontraumatic intracerebral hemorrhage - Fluency disorder following nontraumatic intracerebral hemorrhage
I69.128 Other speech and language deficits following nontraumatic intracerebral hemorrhage
I69.192 Facial weakness following nontraumatic intracerebral hemorrhage
I69.210 Attention and concentration deficit following other nontraumatic intracranial hemorrhage
I69.211 Memory deficit following other nontraumatic intracranial hemorrhage
I69.212 Visuospatial deficit and spatial neglect following other nontraumatic intracranial hemorrhage
I69.213 Psychomotor deficit 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
I69.218 Other symptoms and signs involving cognitive functions following other nontraumatic intracranial hemorrhage
I69.220 - I69.223 Aphasia following other nontraumatic intracranial hemorrhage - Fluency disorder following other nontraumatic intracranial hemorrhage
I69.228 Other speech and language deficits following other nontraumatic intracranial hemorrhage
I69.292 Facial weakness following other nontraumatic intracranial hemorrhage
I69.310 Attention and concentration deficit following cerebral infarction
I69.311 Memory 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
I69.318 Other symptoms and signs involving cognitive functions following cerebral infarction
I69.320 - I69.323 Aphasia following cerebral infarction - Fluency disorder following cerebral infarction
I69.328 Other speech and language deficits following cerebral infarction
I69.392 Facial weakness following cerebral infarction
I69.810 Attention and concentration deficit following other cerebrovascular disease
I69.811 Memory 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
I69.818 Other symptoms and signs involving cognitive functions following other cerebrovascular disease
I69.820 - I69.823 Aphasia following other cerebrovascular disease - Fluency disorder following other cerebrovascular disease
I69.828 Other speech and language deficits following other cerebrovascular disease
I69.892 Facial weakness following other cerebrovascular disease
I69.928 Other speech and language deficits following unspecified cerebrovascular disease
I69.998 Other sequelae following unspecified cerebrovascular disease
J38.00 - J38.02 Paralysis of vocal cords and larynx, unspecified - Paralysis of vocal cords and larynx, bilateral
J38.2 Nodules of vocal cords
J38.3 Other diseases of vocal cords
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 - R48.2 Dyslexia and alexia - Apraxia
R48.8 Other symbolic dysfunctions
R49.0 Dysphonia
R49.1 Aphonia
R49.9 Unspecified voice and resonance disorder
T85.810A Embolism due to nervous system prosthetic devices, implants and grafts, initial encounter
T85.818A Embolism due to other internal prosthetic devices, implants and grafts, initial encounter
T85.820A Fibrosis due to nervous system prosthetic devices, implants and grafts, initial encounter
T85.828A Fibrosis due to other internal prosthetic devices, implants and grafts, initial encounter
T85.830A Hemorrhage due to nervous system prosthetic devices, implants and grafts, initial encounter
T85.838A Hemorrhage due to other internal prosthetic devices, implants and grafts, initial encounter
T85.840A Pain due to nervous system prosthetic devices, implants and grafts, initial encounter
T85.848A Pain due to other internal prosthetic devices, implants and grafts, initial encounter
T85.850A Stenosis due to nervous system prosthetic devices, implants and grafts, initial encounter
T85.858A Stenosis due to other internal prosthetic devices, implants and grafts, initial encounter
T85.860A Thrombosis due to nervous system prosthetic devices, implants and grafts, initial encounter
T85.868A Thrombosis due to other internal prosthetic devices, implants and grafts, initial encounter
T86.8481 Other complications of corneal transplant, right eye
T86.8482 Other complications of corneal transplant, left eye
T86.8483 Other complications of corneal transplant, bilateral
Z01.818 Encounter for other preprocedural examination
Z44.8 Encounter for fitting and adjustment of other external prosthetic devices
Z86.59 Personal history of other mental and behavioral disorders
Z96.3 Presence of artificial larynx
Z97.4 Presence of external hearing-aid

Group 2

(272 Codes)
Group 2 Paragraph

It is the responsibility of the provider to code to the highest level specified in the ICD-10-CM. The correct use of an ICD-10-CM code does not assure coverage of a service. The service must be reasonable and necessary in the specific case and must meet the criteria specified in this determination.

96125

Group 2 Codes
Code Description
F01.50* Vascular dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F01.511* Vascular dementia, unspecified severity, with agitation
F01.518* Vascular dementia, unspecified severity, with other behavioral disturbance
F01.52* Vascular dementia, unspecified severity, with psychotic disturbance
F01.53* Vascular dementia, unspecified severity, with mood disturbance
F01.54* Vascular dementia, unspecified severity, with anxiety
F03.90* Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety
F03.911* Unspecified dementia, unspecified severity, with agitation
F03.918* Unspecified dementia, unspecified severity, with other behavioral disturbance
F03.92* Unspecified dementia, unspecified severity, with psychotic disturbance
F03.93* Unspecified dementia, unspecified severity, with mood disturbance
F03.94* Unspecified dementia, unspecified severity, with anxiety
G20.A1 Parkinson's disease without dyskinesia, without mention of fluctuations
G20.A2 Parkinson's disease without dyskinesia, with fluctuations
G20.B1 Parkinson's disease with dyskinesia, without mention of fluctuations
G20.B2 Parkinson's disease with dyskinesia, with fluctuations
G21.4* Vascular parkinsonism
G30.0* Alzheimer's disease with early onset
G30.1* Alzheimer's disease with late onset
G30.8* Other Alzheimer's disease
G31.09* Other frontotemporal neurocognitive disorder
G31.1* Senile degeneration of brain, not elsewhere classified
R41.840 - R41.844 Attention and concentration deficit - Frontal lobe and executive function deficit
R41.89 Other symptoms and signs involving cognitive functions and awareness
S06.0X0A* Concussion without loss of consciousness, initial encounter
S06.0X1A* Concussion with loss of consciousness of 30 minutes or less, initial encounter
S06.0XAA* Concussion with loss of consciousness status unknown, initial encounter
S06.0XAD* Concussion with loss of consciousness status unknown, subsequent encounter
S06.0XAS* Concussion with loss of consciousness status unknown, sequela
S06.1X0A* Traumatic cerebral edema without loss of consciousness, initial encounter
S06.1X1A* Traumatic cerebral edema with loss of consciousness of 30 minutes or less, initial encounter
S06.1X2A* Traumatic cerebral edema with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.1X3A* Traumatic cerebral edema with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.1X4A* Traumatic cerebral edema with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.1X5A* Traumatic cerebral edema with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.1X6A* Traumatic cerebral edema with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.1X7A* Traumatic cerebral edema with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.1X8A* Traumatic cerebral edema with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.1XAA* Traumatic cerebral edema with loss of consciousness status unknown, initial encounter
S06.1XAD* Traumatic cerebral edema with loss of consciousness status unknown, subsequent encounter
S06.1XAS* Traumatic cerebral edema with loss of consciousness status unknown, sequela
S06.1X9A* Traumatic cerebral edema with loss of consciousness of unspecified duration, initial encounter
S06.2X0A* Diffuse traumatic brain injury without loss of consciousness, initial encounter
S06.2X1A* Diffuse traumatic brain injury with loss of consciousness of 30 minutes or less, initial encounter
S06.2X2A* Diffuse traumatic brain injury with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.2X3A* Diffuse traumatic brain injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.2X4A* Diffuse traumatic brain injury with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.2X5A* Diffuse traumatic brain injury with loss of consciousness greater than 24 hours with return to pre-existing conscious levels, initial encounter
S06.2X6A* Diffuse traumatic brain injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.2X7A* Diffuse traumatic brain injury with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.2X8A* Diffuse traumatic brain injury with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.2XAA* Diffuse traumatic brain injury with loss of consciousness status unknown, initial encounter
S06.2XAD* Diffuse traumatic brain injury with loss of consciousness status unknown, subsequent encounter
S06.2XAS* Diffuse traumatic brain injury with loss of consciousness status unknown, sequela
S06.2X9A* Diffuse traumatic brain injury with loss of consciousness of unspecified duration, initial encounter
S06.300A* Unspecified focal traumatic brain injury without loss of consciousness, initial encounter
S06.301A* Unspecified focal traumatic brain injury with loss of consciousness of 30 minutes or less, initial encounter
S06.302A* Unspecified focal traumatic brain injury with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.303A* Unspecified focal traumatic brain injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.304A* Unspecified focal traumatic brain injury with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.305A* Unspecified focal traumatic brain injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.306A* Unspecified focal traumatic brain injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.307A* Unspecified focal traumatic brain injury with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.308A* Unspecified focal traumatic brain injury with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.30AA* Unspecified focal traumatic brain injury with loss of consciousness status unknown, initial encounter
S06.30AD* Unspecified focal traumatic brain injury with loss of consciousness status unknown, subsequent encounter
S06.30AS* Unspecified focal traumatic brain injury with loss of consciousness status unknown, sequela
S06.309A* Unspecified focal traumatic brain injury with loss of consciousness of unspecified duration, initial encounter
S06.31AA* Contusion and laceration of right cerebrum with loss of consciousness status unknown, initial encounter
S06.31AD* Contusion and laceration of right cerebrum with loss of consciousness status unknown, subsequent encounter
S06.31AS* Contusion and laceration of right cerebrum with loss of consciousness status unknown, sequela
S06.32AA* Contusion and laceration of left cerebrum with loss of consciousness status unknown, initial encounter
S06.32AD* Contusion and laceration of left cerebrum with loss of consciousness status unknown, subsequent encounter
S06.32AS* Contusion and laceration of left cerebrum with loss of consciousness status unknown, sequela
S06.330A* Contusion and laceration of cerebrum, unspecified, without loss of consciousness, initial encounter
S06.331A* Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 30 minutes or less, initial encounter
S06.333A* Contusion and laceration of cerebrum, unspecified, with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.335A* Contusion and laceration of cerebrum, unspecified, with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.336A* Contusion and laceration of cerebrum, unspecified, with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.33AA* Contusion and laceration of cerebrum, unspecified, with loss of consciousness status unknown, initial encounter
S06.33AD* Contusion and laceration of cerebrum, unspecified, with loss of consciousness status unknown, subsequent encounter
S06.33AS* Contusion and laceration of cerebrum, unspecified, with loss of consciousness status unknown, sequela
S06.339A* Contusion and laceration of cerebrum, unspecified, with loss of consciousness of unspecified duration, initial encounter
S06.340A* Traumatic hemorrhage of right cerebrum without loss of consciousness, initial encounter
S06.341A* Traumatic hemorrhage of right cerebrum with loss of consciousness of 30 minutes or less, initial encounter
S06.342A* Traumatic hemorrhage of right cerebrum with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.343A* Traumatic hemorrhage of right cerebrum with loss of consciousness of 1 hours to 5 hours 59 minutes, initial encounter
S06.344A* Traumatic hemorrhage of right cerebrum with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.345A* Traumatic hemorrhage of right cerebrum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.346A* Traumatic hemorrhage of right cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.347A* Traumatic hemorrhage of right cerebrum with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.348A* Traumatic hemorrhage of right cerebrum with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.34AA* Traumatic hemorrhage of right cerebrum with loss of consciousness status unknown, initial encounter
S06.34AD* Traumatic hemorrhage of right cerebrum with loss of consciousness status unknown, subsequent encounter
S06.34AS* Traumatic hemorrhage of right cerebrum with loss of consciousness status unknown, sequela
S06.349A* Traumatic hemorrhage of right cerebrum with loss of consciousness of unspecified duration, initial encounter
S06.350A* Traumatic hemorrhage of left cerebrum without loss of consciousness, initial encounter
S06.351A* Traumatic hemorrhage of left cerebrum with loss of consciousness of 30 minutes or less, initial encounter
S06.352A* Traumatic hemorrhage of left cerebrum with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.353A* Traumatic hemorrhage of left cerebrum with loss of consciousness of 1 hours to 5 hours 59 minutes, initial encounter
S06.354A* Traumatic hemorrhage of left cerebrum with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.355A* Traumatic hemorrhage of left cerebrum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.356A* Traumatic hemorrhage of left cerebrum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.357A* Traumatic hemorrhage of left cerebrum with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.358A* Traumatic hemorrhage of left cerebrum with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.35AA* Traumatic hemorrhage of left cerebrum with loss of consciousness status unknown, initial encounter
S06.35AD* Traumatic hemorrhage of left cerebrum with loss of consciousness status unknown, subsequent encounter
S06.35AS* Traumatic hemorrhage of left cerebrum with loss of consciousness status unknown, sequela
S06.359A* Traumatic hemorrhage of left cerebrum with loss of consciousness of unspecified duration, initial encounter
S06.360A* Traumatic hemorrhage of cerebrum, unspecified, without loss of consciousness, initial encounter
S06.361A* Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 30 minutes or less, initial encounter
S06.362A* Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.363A* Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 1 hours to 5 hours 59 minutes, initial encounter
S06.364A* Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.365A* Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.366A* Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.367A* Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.368A* Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.36AA* Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness status unknown, initial encounter
S06.36AD* Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness status unknown, subsequent encounter
S06.36AS* Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness status unknown, sequela
S06.369A* Traumatic hemorrhage of cerebrum, unspecified, with loss of consciousness of unspecified duration, initial encounter
S06.370A* Contusion, laceration, and hemorrhage of cerebellum without loss of consciousness, initial encounter
S06.371A* Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of 30 minutes or less, initial encounter
S06.372A* Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.373A* Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.374A* Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.375A* Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.376A* Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.377A* Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.378A* Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.37AA* Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness status unknown, initial encounter
S06.37AD* Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness status unknown, subsequent encounter
S06.37AS* Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness status unknown, sequela
S06.379A* Contusion, laceration, and hemorrhage of cerebellum with loss of consciousness of unspecified duration, initial encounter
S06.380A* Contusion, laceration, and hemorrhage of brainstem without loss of consciousness, initial encounter
S06.381A* Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of 30 minutes or less, initial encounter
S06.382A* Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.383A* Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.384A* Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.385A* Contusion, laceration, and hemorrhage of brainstem with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.386A* Contusion, laceration, and hemorrhage of brainstem with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.387A* Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.388A* Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.38AA* Contusion, laceration, and hemorrhage of brainstem with loss of consciousness status unknown, initial encounter
S06.38AD* Contusion, laceration, and hemorrhage of brainstem with loss of consciousness status unknown, subsequent encounter
S06.38AS* Contusion, laceration, and hemorrhage of brainstem with loss of consciousness status unknown, sequela
S06.389A* Contusion, laceration, and hemorrhage of brainstem with loss of consciousness of unspecified duration, initial encounter
S06.4X0A* Epidural hemorrhage without loss of consciousness, initial encounter
S06.4X1A* Epidural hemorrhage with loss of consciousness of 30 minutes or less, initial encounter
S06.4X2A* Epidural hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.4X3A* Epidural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.4X4A* Epidural hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.4X5A* Epidural hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.4X6A* Epidural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.4X7A* Epidural hemorrhage with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.4X8A* Epidural hemorrhage with loss of consciousness of any duration with death due to other causes prior to regaining consciousness, initial encounter
S06.4XAA* Epidural hemorrhage with loss of consciousness status unknown, initial encounter
S06.4XAD* Epidural hemorrhage with loss of consciousness status unknown, subsequent encounter
S06.4XAS* Epidural hemorrhage with loss of consciousness status unknown, sequela
S06.4X9A* Epidural hemorrhage with loss of consciousness of unspecified duration, initial encounter
S06.5X0A* Traumatic subdural hemorrhage without loss of consciousness, initial encounter
S06.5X1A* Traumatic subdural hemorrhage with loss of consciousness of 30 minutes or less, initial encounter
S06.5X2A* Traumatic subdural hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.5X3A* Traumatic subdural hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.5X4A* Traumatic subdural hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.5X5A* Traumatic subdural hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.5X6A* Traumatic subdural hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.5X7A* Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to brain injury before regaining consciousness, initial encounter
S06.5X8A* Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to other cause before regaining consciousness, initial encounter
S06.5XAA* Traumatic subdural hemorrhage with loss of consciousness status unknown, initial encounter
S06.5XAD* Traumatic subdural hemorrhage with loss of consciousness status unknown, subsequent encounter
S06.5XAS* Traumatic subdural hemorrhage with loss of consciousness status unknown, sequela
S06.5X9A* Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter
S06.6X0A* Traumatic subarachnoid hemorrhage without loss of consciousness, initial encounter
S06.6X1A* Traumatic subarachnoid hemorrhage with loss of consciousness of 30 minutes or less, initial encounter
S06.6X2A* Traumatic subarachnoid hemorrhage with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.6X3A* Traumatic subarachnoid hemorrhage with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.6X4A* Traumatic subarachnoid hemorrhage with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.6X5A* Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.6X6A* Traumatic subarachnoid hemorrhage with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.6X7A* Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.6X8A* Traumatic subarachnoid hemorrhage with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.6XAA* Traumatic subarachnoid hemorrhage with loss of consciousness status unknown, initial encounter
S06.6XAD* Traumatic subarachnoid hemorrhage with loss of consciousness status unknown, subsequent encounter
S06.6XAS* Traumatic subarachnoid hemorrhage with loss of consciousness status unknown, sequela
S06.6X9A* Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, initial encounter
S06.810A* Injury of right internal carotid artery, intracranial portion, not elsewhere classified without loss of consciousness, initial encounter
S06.811A* Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 30 minutes or less, initial encounter
S06.812A* Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.813A* Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.814A* Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.815A* Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.816A* Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.817A* Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.818A* Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.81AA* Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness status unknown, initial encounter
S06.81AD* Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness status unknown, subsequent encounter
S06.81AS* Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness status unknown, sequela
S06.819A* Injury of right internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of unspecified duration, initial encounter
S06.820A* Injury of left internal carotid artery, intracranial portion, not elsewhere classified without loss of consciousness, initial encounter
S06.821A* Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 30 minutes or less, initial encounter
S06.822A* Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.823A* Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.824A* Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.825A* Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.826A* Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.827A* Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.828A* Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.82AA* Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness status unknown, initial encounter
S06.82AD* Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness status unknown, subsequent encounter
S06.82AS* Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness status unknown, sequela
S06.829A* Injury of left internal carotid artery, intracranial portion, not elsewhere classified with loss of consciousness of unspecified duration, initial encounter
S06.8A0A* Primary blast injury of brain, not elsewhere classified without loss of consciousness, initial encounter
S06.8A0D* Primary blast injury of brain, not elsewhere classified without loss of consciousness, subsequent encounter
S06.8A0S* Primary blast injury of brain, not elsewhere classified without loss of consciousness, sequela
S06.8A1A* Primary blast injury of brain, not elsewhere classified with loss of consciousness of 30 minutes or less, initial encounter
S06.8A1D* Primary blast injury of brain, not elsewhere classified with loss of consciousness of 30 minutes or less, subsequent encounter
S06.8A1S* Primary blast injury of brain, not elsewhere classified with loss of consciousness of 30 minutes or less, sequela
S06.8A2A* Primary blast injury of brain, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.8A2D* Primary blast injury of brain, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes, subsequent encounter
S06.8A2S* Primary blast injury of brain, not elsewhere classified with loss of consciousness of 31 minutes to 59 minutes, sequela
S06.8A3A* Primary blast injury of brain, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.8A3D* Primary blast injury of brain, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, subsequent encounter
S06.8A3S* Primary blast injury of brain, not elsewhere classified with loss of consciousness of 1 hour to 5 hours 59 minutes, sequela
S06.8A4A* Primary blast injury of brain, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.8A4D* Primary blast injury of brain, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, subsequent encounter
S06.8A4S* Primary blast injury of brain, not elsewhere classified with loss of consciousness of 6 hours to 24 hours, sequela
S06.8A5A* Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.8A5D* Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, subsequent encounter
S06.8A5S* Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours with return to pre-existing conscious level, sequela
S06.8A6A* Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.8A6D* Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, subsequent encounter
S06.8A6S* Primary blast injury of brain, not elsewhere classified with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, sequela
S06.8A7A* Primary blast injury of brain, not elsewhere classified with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.8A8A* Primary blast injury of brain, not elsewhere classified with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.8AAA* Primary blast injury of brain, not elsewhere classified with loss of consciousness status unknown, initial encounter
S06.8AAD* Primary blast injury of brain, not elsewhere classified with loss of consciousness status unknown, subsequent encounter
S06.8AAS* Primary blast injury of brain, not elsewhere classified with loss of consciousness status unknown, sequela
S06.8A9A* Primary blast injury of brain, not elsewhere classified with loss of consciousness of unspecified duration, initial encounter
S06.8A9D* Primary blast injury of brain, not elsewhere classified with loss of consciousness of unspecified duration, subsequent encounter
S06.8A9S* Primary blast injury of brain, not elsewhere classified with loss of consciousness of unspecified duration, sequela
S06.890A* Other specified intracranial injury without loss of consciousness, initial encounter
S06.891A* Other specified intracranial injury with loss of consciousness of 30 minutes or less, initial encounter
S06.892A* Other specified intracranial injury with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.893A* Other specified intracranial injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.894A* Other specified intracranial injury with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.895A* Other specified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.896A* Other specified intracranial injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.897A* Other specified intracranial injury with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.898A* Other specified intracranial injury with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.89AA* Other specified intracranial injury with loss of consciousness status unknown, initial encounter
S06.89AD* Other specified intracranial injury with loss of consciousness status unknown, subsequent encounter
S06.89AS* Other specified intracranial injury with loss of consciousness status unknown, sequela
S06.899A* Other specified intracranial injury with loss of consciousness of unspecified duration, initial encounter
S06.9X0A* Unspecified intracranial injury without loss of consciousness, initial encounter
S06.9X1A* Unspecified intracranial injury with loss of consciousness of 30 minutes or less, initial encounter
S06.9X2A* Unspecified intracranial injury with loss of consciousness of 31 minutes to 59 minutes, initial encounter
S06.9X3A* Unspecified intracranial injury with loss of consciousness of 1 hour to 5 hours 59 minutes, initial encounter
S06.9X4A* Unspecified intracranial injury with loss of consciousness of 6 hours to 24 hours, initial encounter
S06.9X5A* Unspecified intracranial injury with loss of consciousness greater than 24 hours with return to pre-existing conscious level, initial encounter
S06.9X6A* Unspecified intracranial injury with loss of consciousness greater than 24 hours without return to pre-existing conscious level with patient surviving, initial encounter
S06.9X7A* Unspecified intracranial injury with loss of consciousness of any duration with death due to brain injury prior to regaining consciousness, initial encounter
S06.9X8A* Unspecified intracranial injury with loss of consciousness of any duration with death due to other cause prior to regaining consciousness, initial encounter
S06.9XAA* Unspecified intracranial injury with loss of consciousness status unknown, initial encounter
S06.9XAD* Unspecified intracranial injury with loss of consciousness status unknown, subsequent encounter
S06.9XAS* Unspecified intracranial injury with loss of consciousness status unknown, sequela
S06.9X9A* Unspecified intracranial injury with loss of consciousness of unspecified duration, initial encounter
Group 2 Medical Necessity ICD-10-CM Codes Asterisk Explanation

*ICD-10 codes are secondary diagnoses for the coverage of cognitive or speech-language pathology services

N/A

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

Group 1

Group 1 Paragraph

N/A

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
012x Hospital Inpatient (Medicare Part B only)
013x Hospital Outpatient
018x Hospital - Swing Beds
021x Skilled Nursing - Inpatient (Including Medicare Part A)
022x Skilled Nursing - Inpatient (Medicare Part B only)
023x Skilled Nursing - Outpatient
034x Home Health Services not under a plan of treatment
071x Clinic - Rural Health
074x Clinic - Outpatient Rehabilitation Facility (ORF)
075x Clinic - Comprehensive Outpatient Rehabilitation Facility (CORF)
077x Clinic - Federally Qualified Health Center (FQHC)
085x Critical Access Hospital
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.

Revenue codes only apply to providers who bill these services to the Part A MAC. Revenue codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Please note that not all revenue codes apply to every type of bill code. Providers are encouraged to refer to the FISS revenue code file for allowable bill types. Similarly, not all revenue codes apply to each CPT/HCPCS code. Providers are encouraged to refer to the FISS HCPCS file for allowable revenue codes.

All revenue codes billed on the inpatient claim for the dates of service in question may be subject to review.


Code Description
0440 Speech-Language Pathology - General Classification
0444 Speech-Language Pathology - Evaluation or Reevaluation
0449 Speech-Language Pathology - Other Speech Therapy
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
10/01/2023 R12

R12

Revision Effective: 10/01/2023 

Revision Explanation: Annual ICD-10 update, Deleted the following from group 2: G20. Added the following: G20.A1, G20.A2, G20.B1, and G20.B2 

08/03/2023 R11

R11

Revision Effective: 08/03/2023

Revision Explanation: Annual review no changes.

12/15/2022 R10

R10

Revision Effective: 12/15/2022

Revision Explanation: Code S06.896A was left off the revision 8 list of codes that has the asterisk left off in group 2 in error. Codes S06.0XAA, S06.0XAD, S06.0XAS should have also had an asterisk behind the codes in group 2 table but was left off in error. 

12/01/2022 R9

R

Revision Effective: 12/01/2022

Revision Explanation: Added F90.2 to group 1 ICD-10 codes. 

10/01/2022 R8

R8

Revision Effective: 10/01/2022

Revision Explanation: The asterisk was left off of the following ICD-10 codes in group 2 and have been updated to include: 

F01.511, F01.518,F01.52, F01.53, F01.54, F03.911, F03.918, F03.92, F03.93, F03.94, S06.0XAA, S06.0XAD, S06.0XAS, S06.1XAA, S06.1XAD, S06.1XAS, S06.2XAA, S06.2XAD, S06.2XAS, S06.30AA, S06.30AD, S06.30AS, S06.31AA, S06.31AD, S06.31AS, S06.32AA, S06.32AD, S06.32AS, S06.33AA, S06.33AD, S06.33AS, S06.34AA, S06.34AD, S06.34AS, S06.35AA, S06.35AD, S06.35AS, S06.36AA, S06.36AD, S06.36AS, S06.37AA, S06.37AD, S06.37AS, S06.38AA, S06.38AD, S06.38AS, S06.4XAA, S06.4XAD, S06.4XAS, S06.5XAA, S06.5XAD, S06.5XAS, S06.6XAA, S06.6XAD, S06.6XAS, S06.81AA, S06.81AD, S06.81AS, S06.82AA, S06.82AD, S06.82AS, S06.89AA, S06.89AD, S06.89AS, S06.8A0A, S06.8A0D, S06.8A0S, S06.8A1A, S06.8A1D, S06.8A1S, S06.8A2A, S06.8A2D, S06.8A2S, S06.8A3A, S06.8A3D, S06.8A3S, S06.8A4A, S06.8A4D, S06.8A4S, S06.8A5A, S06.8A5D, S06.8A5S, S06.8A6A, S06.8A6D, S06.8A6S, S06.8A7A, S06.8A8A, S06.8A9A, S06.8A9D, S06.8A9S, S06.8AAA, S06.8AAD,S06.8AAS, S06.9XAA, S06.9XAD and S06.9XAS.

10/01/2022 R7

R6

Revision Effective: 10/01/2022

Revision Explanation: Annual ICD-10 Update, Removed F01.51 from group one.

08/04/2022 R6

R6

Revision Effective: 10/01/2022

Revision Explanation: Annual ICD-10 Update, added F01.511, F01.518,F01.52, F01.53, F01.54, F03.911, F03.918, F03.92, F03.93, F03.94, S06.0XAA, S06.0XAD, S06.0XAS, S06.1XAA, S06.1XAD, S06.1XAS, S06.2XAA, S06.2XAD, S06.2XAS, S06.30AA, S06.30AD, S06.30AS, S06.31AA, S06.31AD, S06.31AS, S06.32AA, S06.32AD, S06.32AS, S06.33AA, S06.33AD, S06.33AS, S06.34AA, S06.34AD, S06.34AS, S06.35AA, S06.35AD, S06.35AS, S06.36AA, S06.36AD, S06.36AS, S06.37AA, S06.37AD, S06.37AS, S06.38AA, S06.38AD, S06.38AS, S06.4XAA, S06.4XAD, S06.4XAS, S06.5XAA, S06.5XAD, S06.5XAS, S06.6XAA, S06.6XAD, S06.6XAS, S06.81AA, S06.81AD, S06.81AS, S06.82AA, S06.82AD, S06.82AS, S06.89AA, S06.89AD, S06.89AS, S06.8A0A, S06.8A0D, S06.8A0S, S06.8A1A, S06.8A1D, S06.8A1S, S06.8A2A, S06.8A2D, S06.8A2S, S06.8A3A, S06.8A3D, S06.8A3S, S06.8A4A, S06.8A4D, S06.8A4S, S06.8A5A, S06.8A5D, S06.8A5S, S06.8A6A, S06.8A6D, S06.8A6S, S06.8A7A, S06.8A8A, S06.8A9A, S06.8A9D, S06.8A9S, S06.8AAA, S06.8AAD,S06.8AAS, S06.9XAA, S06.9XAD and S06.9XAS

08/04/2022 R5

R5

Revision Effective: 08/04/2022

Revision Explanation: Annual review, no changes were made.

07/29/2021 R4

R4

Revision Effective: 7/29/2021

Revision Explanation: Annual review, no changes were made.

10/01/2020 R3

R3
Revision Effective: 10/01/2020
Revision Explanation: During annual ICD-10 review T86.848 was deleted and replaced with T86.8481, t86.8482, and T86.8483.

01/01/2020 R2

R2

Revision Effective: n/a

Revision Explanation: Annual review, no changes.

01/01/2020 R1

R1

Revision Effective: 01/01/2020

Revision Explanation: HCPCS code G0515 is end dated 12/31/2019 and replaced with new codes 97129 and 97130 that are effective 01/01/2020 based on HCPCS annual update.

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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
L34046 - 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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Public Versions
Updated On Effective Dates Status
11/07/2023 11/16/2023 - N/A Currently in Effect View
10/30/2023 10/01/2023 - 11/15/2023 Superseded View
09/13/2023 10/01/2023 - N/A Superseded You are here
07/28/2023 08/03/2023 - 09/30/2023 Superseded View
12/09/2022 12/15/2022 - 08/02/2023 Superseded View
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