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LEA Speech-Language and Audiology Billing Code Changes and Telehealth Option

August 29, 2016

Speech-Language and Audiology Assessment CPT-4 Code Changes
Effective for dates of service on or after July 1, 2016, the Local Educational Agency (LEA) Medi-Cal Billing Option program has eliminated CPT-4 code 92506 (evaluation of speech, language, voice, communication, and/or auditory processing) and replaced the code with five new CPT-4 codes for speech-language and audiology assessment services:


CPT-4 Code
Description
92521 Evaluation of speech fluency
92522 Evaluation of speech sound production
92523    with evaluation of language comprehension and expression
92524 Behavioral and qualitative analysis of voice and resonance
92557 Comprehensive audiometry threshold evaluation and speech recognition

Claims submitted with CPT-4 code 92506 for dates of service on or after July 1, 2016, will be denied. However, implementation of the five replacement CPT-4 codes in the claims processing system is not expected to be completed until October 1, 2016.

The Department of Health Care Services (DHCS) instructs LEAs to bill for speech-language and audiology assessment services for dates of service on or after July 1, 2016, in one of two ways:

  1. Submit claims using CPT-4 codes 92521, 92522, 92523, 92524 and 92557, as appropriate. Until the new codes are implemented, these claims will be denied. After the new CPT-4 codes are implemented, an Erroneous Payment Correction (EPC) will reprocess affected claims. No further action will be required of LEAs for these denied claims.

  2. Submit claims after LEAs are notified that implementation of the new CPT-4 codes has occurred in the claims processing system. All billed claims should include CPT-4 codes 92521, 92522, 92523, 92524 and 92557, as appropriate. These claims must comply with other claim submission guidelines.

For more information, providers may refer to Local Educational Agency Service: Speech Therapy, Local Educational Agency Service: Hearing, and Local Educational Agency Billing Codes and Reimbursement Rates.

Implementation of Telehealth Modifier GT for Speech-Language Assessment and Speech Therapy Services
Effective for dates of service on or after July 1, 2016, LEAs may be reimbursed through the LEA Medi-Cal Billing Option program for speech-language assessment and speech therapy treatment services performed via telehealth when services are provided to Medi-Cal eligible students with an Individualized Education Plan or Individualized Family Services Plan.

Claims for speech-language assessment and speech therapy treatment services delivered via telehealth must be billed with the appropriate CPT-4 code and modifier GT (service rendered via interactive audio and video telecommunications systems). However, implementation of the new modifier in the claims processing system is not expected to be completed until October 1, 2016.

DHCS instructs LEAs to bill for speech-language assessment and speech therapy treatment services delivered via telehealth for dates of service on or after July 1, 2016, in one of two ways:

  1. Submit claims using the new CPT-4 codes noted above, as appropriate, with telehealth modifier GT. Until the new codes are implemented, these claims will be denied. After the new CPT-4 codes are implemented, an EPC will reprocess affected claims. No further action will be required of LEAs for these denied claims.

  2. Submit claims after LEAs are notified that implementation of the new CPT-4 codes and modifier GT has occurred in the claims processing system. All billed claims should include CPT-4 codes 92521, 92522, 92523, 92524 and 92557, as appropriate, along with modifier GT. These claims must comply with other claim submission guidelines.

For more information, providers may refer to Local Educational Agency: Telehealth.