Therapy CPT CODE – 92507, 97124, 92526, 97532, 92506 with time

Covered Codes for Speech  Therapy Providers

Cognitive Skills Development (CPT code 97532)

1. This procedure is reasonable and necessary for patients who have a disease or injury in which impairment of cognitive functioning is documented. Impaired functions may include but are not limited to ability to follow simple commands, attention to tasks, problem solving skills, memory, ability to follow numerous steps in a process, perform in a logical sequence and ability to compute.

2. This procedure is reasonable and necessary only when it requires the skills of an occupational therapist and is designed to address specific needs of the patient and is part of the written plan of care.

3. Treatment techniques utilized include but are not limited to recall of information, tabletop graded activities focusing on attentional skills (e.g. cancellation tasks, mazes), and graded processes in steps, which patient must follow to complete task, computer programs that focus on the above.

4. Development of cognitive skills must be reasonable and necessary to restore and improve functioning of the patient. Documentation must relate the training to expected functional goals that are attainable by the patient.

5. Services provided concurrently by physicians, occupational therapists and speech therapists may be covered, if separate and distinct goals are documented in the written plan of treatment.


Billing for “Sometimes Therapy” Services that May be Paid as Non-Therapy Services for Hospital Outpatients

Section 1834(k) of the Act, as added by Section 4541 of the BBA, allows payment at 80 percent of the lesser of the actual charge for the services or the applicable fee schedule amount for all outpatient therapy services; that is, physical therapy services, speech-language pathology services, and occupational therapy services. As provided under Section 1834(k)(5) of the Act, a therapy code list was created based on a uniform coding system (that is, the HCPCS) to identify and track these outpatient therapy services paid under the Medicare Physician Fee Schedule (MPFS).

The list of therapy codes, along with their respective designation, can be found on the CMS Website, specifically at
http://www.cms.hhs.gov/TherapyServices/05_Annual_Therapy_Update.asp#TopOfPage. Two of the designations that are used for therapy services are: “always therapy” and “sometimes therapy.” An “always therapy” service must be performed by a qualified therapist under a certified therapy plan of care, and a “sometimes therapy” service may be performed by physician or a non-physician practitioner outside of a certified therapy plan of care.

Under the OPPS, separate payment is provided for certain services designated as “sometimes therapy” services if these services are furnished to hospital outpatients as a non-therapy service, that is, without a certified therapy plan of care. Specifically, to be paid under the OPPS for a non-therapy service, hospitals SHOULD NOT append the therapy modifier GP (physical therapy), GO (occupational therapy), or GN (speech language pathology), or report a therapy revenue code 042x, 043x, or 044x in association with the “sometimes therapy” codes listed in the table below.

To receive payment under the MPFS, when “sometimes therapy” services are performed by a qualified therapist under a certified therapy plan of care, providers should append the appropriate therapy modifier GP, GO, or GN, and report the charges under an appropriate therapy revenue code, specifically 042x, 043x, or 044x. This instruction does not apply to claims for “sometimes therapy” codes furnished as non-therapy services in the hospital outpatient department and paid under the OPPS.

Effective January 1, 2015, two HCPCS codes designated as “Sometimes Therapy” services, G0456 (Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters) and G0457 (Negative pressure wound therapy, (e.g. vacuum assisted drainage collection) using a mechanically-powered device, not durable medical equipment, including provision of cartridge and dressing(s), topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters) would be terminated and replaced with two new Procedure  codes 97607 (Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters) and 97608 (Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters).

The list of HCPCS codes designated as “sometimes therapy” services that may be paid as non-therapy services when furnished to hospital outpatients is displayed in the table below.

Services Designated as “Sometimes Therapy” that May be Paid as Non-Therapy Services for Hospital Outpatients

HCPCS Code            Long Descriptor

92520

Laryngeal function studies (i.e., aerodynamic testing and acoustic testing)

97597

Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (eg., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimeters

97598

Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g., high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area greater than 20 square centimeters

97602

Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session

97605

Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters

97606

Negative pressure wound therapy (e.g., vacuum assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters

97607

Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area less than or equal to 50 square centimeters

97608

Negative pressure wound therapy, (eg, vacuum assisted drainage collection), utilizing disposable, non-durable medical equipment including provision of exudate management collection system, topical application(s), wound assessment, and instructions for ongoing care, per session; total wounds(s) surface area greater than 50 square centimeters

97610

Low frequency, non-contact, non-thermal ultrasound, including topical application(s), when performed, wound assessment, and instruction(s) for ongoing care, per day

1. Speech/hearing treatment (CPT 92507)

The treatment/intervention, (e.g., prevention, restoration, amelioration, and compensation) and follow-up services for disorders of speech, articulation, fluency and voice, language skills and the cognitive aspects of communication:

a. Providing consultation, counseling, and making referrals when appropriate;

b. Providing training and support to family members/caregivers and other communication partners of individuals with speech, voice, language, communication, fluency, hearing and swallowing disabilities;

c. Developing and establishing effective augmentative and alternative communication techniques and strategies, including selecting, prescribing and dispensing of aids and devices as identified by State Practice Acts and training individuals, their family members/caregivers, and other communication partners in their use. Regarding speech generating devices, use CPT 92607 for selection and prescription; use CPT 92609 for adaptation and training;

d. Selecting, fitting, and establishing effective use of appropriate prosthetic/adaptive devices for speaking;

e. Providing aural rehabilitation and related counseling services to individuals with hearing loss and to their family members/caregivers;

f. Providing interventions for individuals with central auditory processing disorders.




92507 Treatment of speech, language, voice, communication,
and/or auditory processing disorder; individual $79.77

92606 Therapeutic service(s) for the use of non-speechgenerating
device, including programming and
modification. This code is bundled with CPT code 92507

Procedure codes 92507, 92526, 92630, 92633, and 97535 require modifier GN.

Speech therapy treatment will be denied when billed by any provider on the same day as a speech therapy evaluation or reevaluation.

Procedure codes 92507, 92526, and 97535 may be reimbursed in 15-minute increments up to 1 hour per day by the same provider. Time that can be billed for therapy sessions includes the time the therapist:

• Prepares the client for the session,
• Is with the client, and
• Is completing documentation.

Providers should not bill for services performed less than 8 minutes.

Providers may bill for two auditory rehabilitation procedure codes (92630 and 92633) a day

Speech therapy treatment will be denied when billed by any provider on the same day as a speech therapy evaluation or reevaluation.

Procedure codes 92507, 92526, and 97535 may be reimbursed in 15-minute increments up to 1 hour per day by the same provider. Time that can be billed for therapy sessions includes the time the therapist:

• Prepares the client for the session,
• Is with the client, and
• Is completing documentation.

Providers should not bill for services performed less than 8 minutes. Providers may bill for two auditory rehabilitation procedure codes (92630 and 92633) a day

The following documentation must be submitted for consideration for authorization:

• A “CSHCN Services Program Authorization Request for Initial Outpatient Therapy (TP1)” form or “CSHCN Services Program Authorization Request for Extension of  utpatient Therapy (TP2)” form must be submitted prior to the start of care for the current episode of therapy.

• The most recent evaluation and treatment plan including:
• Documented age of the client.
• Diagnosis.
• Description of specific therapy being prescribed.
• Specific treatment goals.
• Anticipated measurable progress toward goals.
• Duration and frequency of therapy.
• Requested dates of service.