Four new assessment codes were developed by ASHA's Health Care Economics Committee (HCEC) in collaboration with experts in the field. The HCEC has been working with the American Medical Association (AMA) to change most speech-language pathology codes since 2009. These most recent changes took effect in California on October 1, 2016.
Since then, there has been some confusion concerning how to bill for an assessment that only includes language evaluation. We have clarification from ASHA and their website explains this in their FAQ’s ( http://www.asha.org/Practice/reimbursement/coding/New-CPT-Evaluation-Codes-for-SLPs/#7). The SLP should document that his/her clinical judgement was used to determine a student’s speech capabilities and whether or not the student should receive a sound production assessment. According to ASHA, this clinical judgement implies that an assessment was made even if it was determined that there was no need for a formal assessment for sound production. Below is the response from ASHA:
“If two or more procedures are billed together at least 51% of the time, it is standard to develop a bundled CPT code for that set of services. During the code development process, ASHA surveyed practices and clinics and confirmed that a patient evaluated for language is also evaluated for speech sound production ability more than 80% of the time. However, the reverse is not true. It is common practice for a patient to be evaluated for speech sound production ability independent of a language evaluation, which is why there is a stand-alone code for speech sound production evaluation
However, SLPs will often address both speech and language throughout the evaluation process, even if only evaluating speech sound production informally. In these instances, SLPs may document that speech sound production is within normal limits and could also provide further detail regarding intelligibility at the sentence and conversational level, as well as explain the results of an orofacial examination for structure and function of articulators.”