Note: This article contains information that is only relevant to American clinics.
Physical therapists and Occupational therapists have clearly defined CPT codes for re-evaluations. Speech language pathologists (SLPs), on the other hand, don’t have it as easy. The fact is that not all insurance carriers cover the costs of re-evaluations for SLPs, and those that do have a roundabout way or categorizing these costs.
Fortunately a recent article from Gawenda Seminars & Consulting went into detail about “how to bill for a re-evaluation to Medicare and private insurance carriers [by] revealing the [CPT} re-evaluation code,” and listing several insurance carriers that pay for a largely unknown code.
There is not a specific CPT code that is dedicated to an SLP’s re-evaluation in the Medicare program. Gawenda’s article stated that “If the SLP needs to perform a re-evaluation on a Medicare Part B beneficiary, the SLP is to bill the re-evaluation using the appropriate evaluation CPT code (i.e. 92521 – 92525 and 92610).” Clinics need to bill for re-evaluations using these codes, despite the fact that they’re technically meant for evaluations.
Now let’s take a look at how you would bill Medicaid and commercial or private insurance carriers for a re-evaluation. If you know that your state’s Medicaid program and insurance carriers will reimburse you for re-evaluations when you use evaluation codes the same way that Medicare does, then you’re free to submit invoices with the same codes. But, this is not the case universally.
Some Medicaid and insurance carriers use a re-evaluation code that does not belong to the Level 1 CPT codes that you’re accustomed to using. Instead, they use a different coding book called the Healthcare Common Procedure Coding System (HCPCS) Level 2 Codes. The specific code that Gawenda’s article refers to is S9152, which translates into a speech therapy re-evaluation.
The article was capped off by stating that “The inclusion of a code does not imply a right to reimbursement.” As we all know, the requirements for reimbursement vary from payor to payor, and it’s up to you to ensure that your submissions are “up to code.”