Medicare Covers Cognitive Therapy National and local Medicare policy statements clearly support coverage of cognitive therapy services provided by speech-language pathologists. Each of the major carriers and fiscal intermediaries that have posted Local Coverage Determinations (LCDs) for speech-language services list CPT 97532 (Cognitive skills development, each 15 minutes) as a covered procedure. Also, CPT ... Bottom Line
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Bottom Line  |   May 01, 2006
Medicare Covers Cognitive Therapy
Author Notes
  • Mark Kander, is director of health care regulatory analysis. Contact him at mkander@asha.org.
    Mark Kander, is director of health care regulatory analysis. Contact him at mkander@asha.org.×
Article Information
Practice Management / Bottom Line
Bottom Line   |   May 01, 2006
Medicare Covers Cognitive Therapy
The ASHA Leader, May 2006, Vol. 11, 3-14. doi:10.1044/leader.BML.11072006.3
The ASHA Leader, May 2006, Vol. 11, 3-14. doi:10.1044/leader.BML.11072006.3
National and local Medicare policy statements clearly support coverage of cognitive therapy services provided by speech-language pathologists. Each of the major carriers and fiscal intermediaries that have posted Local Coverage Determinations (LCDs) for speech-language services list CPT 97532 (Cognitive skills development, each 15 minutes) as a covered procedure. Also, CPT 92507 (Treatment of speech, language, voice, communication and/or auditory processing disorder) is acceptable for reporting cognitive communication services, according to CMS Program Memorandum AB-00-14, March 2000.
Note that both codes should not be reported for the same session of a cognitive-communication disorder visit. Further evidence of Medicare coverage is found in a 2001 Program Memorandum from the Centers for Medicare and Medicaid Services (CMS), “Medical Review of Services for Patients with Dementia.”
The following excerpt can be cited when appealing denials of cognitive therapy coverage when rendered by a speech-language pathologist:
Dementia is the general loss of cognitive abilities, including an impairment of memory, and may include one or more of the following: aphasia, apraxia, agnosia, or disturbed planning, organizing, and abstract thinking abilities. . . . Throughout the course of their disease, patients with dementia may benefit from pharmacologic, physical, occupational, speech-language pathology, and other therapies, according to CMS Program Memorandum AB-01-135, September 25, 2001. [ASHA note: Late stage dementia that prevents functional progress or maintenance care would not generally be covered by Medicare.]
Despite the coverage policies mentioned above, ASHA receives reports from members stating categorically that cognitive-communication services are not covered by Medicare or that a large percentage of cognitive treatment claims are denied.
One member characterized Mutual of Omaha, one of the major Medicare intermediaries, as largely rejecting cognitive-communication therapy claims. Conse-quently, ASHA recently discussed this complaint with the Mutual of Omaha lead speech-language pathology consultant and he explained the SLP claims review process according to intermediaries usually review only a random sampling of claims. A focused review of certain types of speech-language pathology claims or claims from specific facilities occurs when abuse is suspected.
Mutual does recognize cognitive-communication services as covered services by SLPs but will deny such claims for the common reasons listed below:
  • Therapy, such as for memory and/or orientation, that is not linked to specific functional communication goals

  • Therapy that does not yield significant functional progress. Rather, the patient may be appropriate for the establishment of a maintenance program and sessions necessary to train other caregivers and family

  • Preparation of memory aids or memory books that do not require the skills of a speech-language pathologist

ASHA asks members to submit descriptions of denied cognitive services, summarized by dates, quantity of claims, reasons for denial, and the carrier/intermediary. All submissions should be made with HIPAA privacy compliance in mind. Please send descriptions to Mark Kander. Contact him at 800-498-4071, ext. 4139 or by e-mail at mkander@asha.org.
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May 2006
Volume 11, Issue 7