Coverage for Voice Treatment Many speech-language pathologists have concerns about public and private health plan coverage of evaluation and treatment of voice disorders. The questions and answers that follow offer some general guidance on coding and reimbursement for voice disorders, but providers should always examine the language of the patient’s health insurance policy for ... Bottom Line
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Bottom Line  |   November 01, 2010
Coverage for Voice Treatment
Author Notes
  • Mark Kander, is the director of health care regulatory analysis, and can be reached at mkander@asha.org.
    Mark Kander, is the director of health care regulatory analysis, and can be reached at mkander@asha.org.×
Article Information
Speech, Voice & Prosodic Disorders / Voice Disorders / Bottom Line
Bottom Line   |   November 01, 2010
Coverage for Voice Treatment
The ASHA Leader, November 2010, Vol. 15, 3-30. doi:10.1044/leader.BML1.15142010.3
The ASHA Leader, November 2010, Vol. 15, 3-30. doi:10.1044/leader.BML1.15142010.3
Many speech-language pathologists have concerns about public and private health plan coverage of evaluation and treatment of voice disorders. The questions and answers that follow offer some general guidance on coding and reimbursement for voice disorders, but providers should always examine the language of the patient’s health insurance policy for specific coverage information. In addition, Medicare guidelines permit a nurse practitioner, physician assistant, or clinical nurse specialist to perform physician responsibilities (e.g., referral), provided state law allows these practitioners to do so.
Q: After performing an evaluation of speech, language, communication, and auditory processing, a provider may determine that a voice evaluation is indicated. Can the provider bill a voice evaluation separately?
No. The Current Procedural Terminology (CPT; © American Medical Association) code for a speech-language evaluation (92506) includes “voice” in its descriptor. Because payment is for a comprehensive evaluation, a second evaluation usually would not be covered unless the SLP can document a significant change in the patient’s overall condition.
Q: Is it possible to be reimbursed for a voice evaluation (92506) and a swallowing evaluation (92610) provided on the same day?
Yes, both codes may be billed on the same day. A voice evaluation and a swallowing evaluation are two distinct entities. There is no Medicare restriction for billing these two services on the same day (and private health plans sometimes adopt Medicare restrictions), but each evaluation should be fully documented. If payment is denied, determine the payer’s justification for denial and seek an appeal. (Note: A list of services that Medicare does not allow to be performed on the same day can be found at ASHA’s Correct Coding webpage).
Q: Is an SLP permitted to perform a videostroboscopy (31579) without physician supervision?
Three major issues determine the answer to this question—Medicare, state regulations/licensure laws, and physician employment.
Videostroboscopy is not a “therapy” procedure under Medicare, and thus it cannot be billed by an SLP. If an SLP is an employee of a physician, physician group, or physician-directed clinic, the Medicare “incident to physician services” rule allows the SLP to perform a videostroboscopy if a physician is present in the office suite, but not necessarily in the same room.
For private health plans, state regulations and licensure laws may determine whether or not an SLP may perform videostroboscopy.
Q: Should I always require a physician referral for voice evaluation/treatment?
Most private health plans require a physician referral for any speech-language assessment. For voice cases, ASHA’s Preferred Practice Patterns note that, “All patients/clients with voice disorders are examined by a physician, preferably in a discipline appropriate to the presenting complaint. The physician’s examination may occur before or after the voice evaluation by the speech-language pathologist.” Medicare does not require an initial physician referral/order. However, within 30 days of the evaluation, a physician must approve the plan of care (POC). The approval may be in effect for up to 90 days, but can be limited to any length at the physician’s discretion.
Q: Are there new Medicare restrictions on the acquisition of tracheoesophageal prostheses (TEPs)?
Yes. As of Oct. 1, 2010, Medicare is enforcing a longstanding requirement that prohibits a patient from acquiring a medical device that must be changed or inserted by a health professional (see The ASHA Leader, Sept. 21, 2010). ASHA disputed this decision, noting excessive inventory-acquisition costs for physicians and clinics that must keep large numbers of TEPs in stock because of the variety of sizes and designs required. ASHA also raised the safety issue for patients who must replace a TEP on short notice and, perhaps, while traveling. ASHA continues to work with physicians, manufacturers, and SLPs to change this Medicare policy.
Q: Is there a CPT code specifically for training a patient to use a TEP and making necessary modifications to the prosthesis?
There is no specific code, but these services are included in 92507, Treatment of speech, language, voice, communication, and/or auditory processing disorder.
Q: Is there a CPT code for patient evaluation to determine if a TEP would be appropriate and beneficial?
Yes. The correct CPT code to use for the evaluation and for replacement is 92597, Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech.
The Reimbursement Committee of Special Interest Division 3, Voice and Voice Disorders, contributed to this article. For more information about Medicare, contactMark Kander,director of health care regulatory analysis, at mkander@asha.org. For information on private insurance, contactJanet McCarty, MEd, CCC-SLP, private health plans advisor, at jmccarty@asha.org.
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November 2010
Volume 15, Issue 14