New SLP Evaluation Codes: One Year Later A year after regulations replaced a broad speech-language evaluation procedure code with four codes specific to different evaluations, how is the new system working? Bottom Line
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Bottom Line  |   January 01, 2015
New SLP Evaluation Codes: One Year Later
Author Notes
  • Neela Swanson is ASHA director of health care coding policy. nswanson@asha.org
    Neela Swanson is ASHA director of health care coding policy. nswanson@asha.org×
  • Laurie Alban Havens, MA, CCC-SLP, is ASHA director of private health plans and Medicaid advocacy. lalbanhavens@asha.org
    Laurie Alban Havens, MA, CCC-SLP, is ASHA director of private health plans and Medicaid advocacy. lalbanhavens@asha.org×
  • Janet McCarty, MEd, CCC-SLP, is ASHA private health plans advisor. jmccarty@asha.org
    Janet McCarty, MEd, CCC-SLP, is ASHA private health plans advisor. jmccarty@asha.org×
Article Information
Speech, Voice & Prosodic Disorders / Practice Management / Regulatory, Legislative & Advocacy / Language Disorders / Bottom Line
Bottom Line   |   January 01, 2015
New SLP Evaluation Codes: One Year Later
The ASHA Leader, January 2015, Vol. 20, 25-29. doi:10.1044/leader.BML.20012015.28
The ASHA Leader, January 2015, Vol. 20, 25-29. doi:10.1044/leader.BML.20012015.28
New coding and billing rules implemented Jan. 1, 2014, drastically changed the way speech-language pathologists code and bill for evaluations—and SLPs and insurers are still adjusting to the new system.
Under the old system, all speech, language and voice evaluations fell under one broad code. Now, there are four different evaluation codes, each covering a specific type of evaluation. In addition, one of the codes may require a specific notation (the -52 modifier) under certain circumstances (see box below).
What have we learned since the new codes were implemented? We know that some payers, including Medicaid programs, are inconsistent in use of the codes, and also can’t accommodate the -52 modifier in their systems. Here are some pointers for moving into 2015.
I evaluated a child for a language disorder. Should I use 92523 (evaluation of speech sound production and evaluation of language comprehension and expression) with a -52 modifier (reduced service)?
The correct code depends on what, exactly, you are evaluating. If an SLP evaluates language only, with no documentation of a formal or informal assessment of speech, ASHA advises using CPT code 92523 with the -52 modifier, which is used when the services provided are less than the full description of the code.
However, consider a different scenario. An SLP often addresses both speech and language throughout the evaluation process, even if evaluating speech only informally. Under this scenario, the SLP should document that speech-sound production was within normal limits. Documentation should provide further detail regarding sentence- and conversation-level intelligibility, as well as the results of an orofacial examination for structure and function of articulators. When there is documentation that the SLP used clinical judgment to determine a patient’s speech capabilities, it is appropriate to bill 92523 without a -52 modifier.
How do I bill for a cognitive evaluation that does not include standardized testing? Can I use 92523 (evaluation of speech sound production and evaluation of language comprehension and expression)?
92523 is probably not appropriate for in this case. If you are assessing cognitive skills using only nonstandardized tools, but in conjunction with a full speech and language evaluation, you may use CPT 92523. However, speech-language abilities should be the dominant focus.
You can bill CPT 96125 (standardized cognitive performance testing) if you use a standardized cognitive test and if takes at least 31 minutes to conduct the evaluation, interpret the results and write the report.
If you provide a cognitive-only evaluation (for example, memory, attention, executive function), but do not use standardized testing, there is no appropriate billing code.
What about evaluations for a non-speech-generating device? I used to use 92506 to bill Medicare for this. When the new codes were published, Medicare didn’t provide any new guidance on what to do.
When ASHA staff discussed this issue with representatives from the Centers for Medicare and Medicaid Services, CMS made it clear that non-SGD evaluation services are considered “bundled” (that is, not separately billable). Instead, SLPs should capture that evaluation under any other services the SLP provides that day (for example, 92523, evaluation of speech-sound production and language comprehension and expression; or 92507, treatment of speech, language, voice, communication, and/or auditory processing disorder).
ASHA and CMS are investigating alternatives for evaluations for non-SGD services provided alone, which are now not billable under CMS interpretation. Check with Medicaid and other third-party payers regarding their specific policies, though many will follow CMS.
Some of my payers still don’t recognize the new codes or use them incorrectly. What’s going on?
Many payers, specifically Medicaid, have been slow to implement the use of the new codes. If a Medicaid program continues to accept 92506, the program may subsequently realize the code has been retired and could rescind payment to providers who submitted it. In addition, some Medicaid agencies misunderstand the new code: They assume that SLPs use all four codes for every client evaluated, and therefore divide the reimbursement for 92506 by four, resulting in inappropriately low reimbursement when only one evaluation was conducted (see sidebar below for other examples of known problems). ASHA staff members continue to work case-bycase with state Medicaid offices and other payers to resolve these issues.
Different State, Different Code Adaptation

Medicaid programs across the country continue to have difficulties with the new speech-language evaluation codes. Here are some examples that ASHA has attempted to address:

  • Florida Medicaid implemented the new codes in May. However, Florida has historically used the 92506 to cover all evaluations, including swallowing (it had never used the 92610 swallowing evaluation code), and tried to include swallowing in one of the new codes. The program has now agreed to incorporate the 92610 code into its billing system, but has yet to do so. Until this issue is resolved, providers cannot bill swallowing evaluations for Medicaid-eligible clients.

  • In New Hampshire, NH Medicaid implemented the new codes, but has been unable to program its system to appropriately reimburse them. NH Medicaid reports it is working to fix this situation.

  • California’s Medi-Cal, like Florida, had been using 92506 for all evaluations, including audiology evaluations. Because California uses a unique coding system, Medi-Cal initially continued to use 92506 for audiology evaluations. The state program is working on changing the codes used for audiology evaluations.

The New Codes

New CPT (Current Procedural Terminology © American Medical Association) rules for coding and billing speech-language evaluations went into effect Jan. 1, 2014. The rules replaced the general evaluation code with four codes specific to the type of evaluation.

Old code

CPT 92506, Evaluation of speech, language, voice, communication, and/or auditory processing.

New codes
  • 92521, Evaluation of speech fluency (stuttering, cluttering).

  • 92522, Evaluation of speech sound production (articulation, phonological process, apraxia, dysarthria).

  • 92523, Evaluation of speech sound production (articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (receptive and expressive language). Evaluations for language only should include the -52 modifier, which indicates that services provided are less than the full description of the code.

  • 92524, Behavioral and qualitative analysis of voice and resonance.

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January 2015
Volume 20, Issue 1