Speech Therapy 

CPT code 92611

CPT code 92611, 92611 CPT code

CPT Code 92611 should be familiar to speech-language pathologists who complete swallow studies under radiology.

According to ASHA, this code represents the SLP's participation in a modified barium swallow study (MBS) of videofluoroscopy.

Proper coding is essential to ensure therapists complete billing accurately and adequately document the services provided. Using the CPT code also helps ensure reimbursement.

Let's review all the information SLPs need about CPT Code 92611. We'll discuss indications for using the code, procedures covered, documentation guidelines, and other important considerations.


→ Click here to enroll in our free on-demand Insurance Billing for Therapists video course [Enroll Now]


What is CPT Code 92611

The CPT Code 92611 describes "Motion fluoroscopic evaluation of swallowing function by cine or video-recording." ASHA states that the CPT Code 92611 "reflects the SLP's work during the study."

SLPs must distinguish CPT 92611 from CPT 92610. CPT 92610 refers to the Evaluation of Oral and Pharyngeal Swallowing Function and is typically reported before CPT code 92611 is billed.

The 92611 code represents the speech-language pathologist's participation in the MBS (modified barium swallow) study, also known as videofluoroscopic swallow study (VFSS). SLPs complete this study in collaboration with a radiologist. Radiologists participating in the study will use a separate CPT code, 74230.

CPT code 92611 applies to individuals of all ages who present with dysphagia and swallowing dysfunction either at the oral or pharyngeal level. Eligibility is determined based on the SLP's clinical assessment and diagnosis.



Indications and conditions for using CPT code 92611

CPT code 92611 is used when the SLP assesses swallowing function in individuals with swallowing disorders (dysphagia), which may co-occur in individuals with speech and language disorders or cognitive-communication disorders.

Communication disorders and dysphagia often co-occur in clients with neurological impairments, such as stroke or traumatic brain injury (TBI).

In the pediatric population, diagnoses such as developmental delays, prematurity, and cleft lip/palate are linked to both communication impairments and swallowing disorders.

Therefore, the use of CPT code 92611 for a Modified Barium Swallow Study may be indicated in some instances.

Procedures and techniques covered under CPT code 92611

When performing a Modified Barium Swallow Study (MBS), several procedures and techniques are involved at specific phases for Speech-Language Pathologists.

Evaluation

The MBS, a videofluoroscopy swallow study, evaluates swallowing function, which involves several key steps:
  • Review of medical history. The SLP prepares by gathering information about the client's medical history, noting any relevant diagnoses (such as neurological or genetic disorders), history of swallowing difficulties, or other pertinent information.

  • Clinical examination. In conjunction with a radiologist, the SLP assesses the client's swallow function at the oral and pharyngeal levels as the client swallows various consistencies of barium-coated food and liquid under fluoroscopy. Real-time imaging allows the speech therapist to identify any abnormalities or difficulties in the swallowing mechanics of the individual.

Treatment planning

Based on the findings from the evaluation, the SLP develops an individualized, comprehensive treatment plan involving:
  • Goal setting. The SLP establishes functional goals to address the swallowing impairments identified during the swallow study, including improving oral control or reducing aspiration risk.

  • Client/caregiver education. Therapists educate the client and caregivers about the nature of the swallowing disorder, any recommended modifications (such as modified diet consistencies), and strategies for improving swallowing safety.

Intervention techniques

The SLP selects appropriate intervention techniques to address the client's swallowing difficulties. These may include:
  • Oral motor exercises

  • Compensatory strategies (techniques to reduce aspiration risk, such as modifying positioning or thickening liquids)

  • Behavioral techniques (strategies that can improve the timing or coordination involved in swallowing, such as the effortful swallowing technique)

Documentation requirements

The SLP must complete accurate and detailed documentation when using the CPT code 92611 for completing a modified barium swallow study/ videofluoroscopy swallow study and includes:
  • Procedure documentation. The SLP records the specific procedure completed, including what types of foods and liquids were tested, the client's positioning, and the results.

  • Assessment findings. Within the evaluation report, the therapist interprets the results of the fluoroscopic findings and reports any identified swallowing impairments.

  • Treatment Plan. Goals, objectives, and intervention recommendations are reported.

  • Plan of care. Therapists can send a recommended care plan to the client's primary care physician and other providers.


Watch this video to learn common insurance billing struggles and solutions



→ Start My Free Trial


Documentation guidelines for CPT code 92611

To ensure accurate billing, SLPs must include detailed documentation reflecting the fluoroscopic swallow study as the completed procedure.

Documentation typically consists of an evaluation report that includes details regarding the client's medical history, clinical examination findings, and specific observations from the swallow study procedure.

The clinician may include essential documentation such as the types of food and liquid consistencies tested, the study results, any impairments identified, and clinical recommendations.

Common pitfalls to avoid include:
  • Not documenting sufficient detail when describing the client's swallow impairments.

  • Not documenting the clinical rationale for skilled intervention with specific techniques or modifications.

  • Omitting any associated medical diagnoses.

Clear and thorough documentation can help ensure accurate billing and reimbursement of services provided as part of a videofluoroscopic swallow evaluation.


→ Download My Free Insurance Billing Guide


Reimbursement and billing considerations

Medicare and most insurance plans typically cover the CPT code 92611 when medically necessary.

Proper billing practices include ensuring accurate, thorough documentation of the procedure's details, such as documenting the client's medical history, findings from the examination, and other specific observations made during the swallow study.

The CPT code 92611 reimbursement rates vary depending on the payer and geographic location. Limitations may exist, such as restrictions on the procedure frequency or prior authorization requirements.

Clinicians must remain informed about coverage policies and billing guidelines to facilitate timely and accurate reimbursement for services provided under the CPT code 92611.

Compliance and regulatory considerations

Following CPT guidelines is critical when using code 92611 to bill a swallow study under fluoroscopy. The clinician must ensure that the procedure and documentation completed meet the specific criteria outlined by the American Medical Association.

SLPs must also comply with other relevant healthcare regulations, such as HIPAA privacy and Medicare billing regulations, which ensure the protection of client information but maintain compliance with guidelines to avoid penalties.

Potential penalties for non-compliance with these regulations include fines, licensure loss, and exclusion from federal healthcare programs. Therefore, Speech-Language Pathologists need to adhere to regulatory standards.

Speech-language pathologists should use the CPT code 92611 when documenting and billing their participation in a modified barium swallow study (MBS) of videofluoroscopy.

Therapists can use CPT code 92611 with clients of any age who have known or suspected dysphagia (disordered swallowing). Documentation includes an evaluation report consisting of a description and analysis of the findings from the procedure.

SLPs must ensure the CPT code 92611 is being utilized properly. This can not only allow for proper reimbursement of services but also help therapists adhere to regulations and avoid harsh penalties.

How EHR and practice management software can save you time with insurance billing for therapists

EHR with integrated billing software and a clearing house, such as TheraPlatform, offers significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.

What are automation and batching?

  • Automation refers to setting up software to perform tasks with limited human interaction.

  • Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.

Which billing and medical claim tasks can be automated and batched through billing software?

  • Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.

  • Credit card processing: Charge multiple clients with a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!).

  • Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.

  • Live claim validation: The system reviews each claim to catch human errors before submission, saving you time and reducing rejected claims.

  • Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.

  • Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.

Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time regarding insurance billing for therapists.

Resources

TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports different industries and sizes of practices, including speech-language pathologists in group and solo practices.




More resources


Free video classes


References

Ghoreyshi, Z., Nilipour, R., Bayat, N., Nejad, S. S., Mehrpour, M., & Azimi, T. (2022). The incidence of aphasia, cognitive deficits, apraxia, dysarthria, and dysphagia in acute post-stroke Persian-speaking adults. Indian Journal of Otolaryngology and Head & Neck Surgery, 74(Suppl 3), 5685-5695. https://doi.org/10.1007/s12070-021-03006-9

Martin-Harris, B., Bonilha, H. S., Brodsky, M. B., Francis, D. O., Fynes, M. M., Martino, R., ... & Zarzour, J. (2021). The modified barium swallow study for oropharyngeal dysphagia: Recommendations from an interdisciplinary expert panel. Perspectives of the ASHA Special Interest Groups, 6(3), 610-619. https://doi.org/10.1044/2021_PERSP-20-00303

Smith, J. B., O'Donoghue, C., & Jones, R. (2024). Speech-Language Pathologists' Use of Side-Lying Position in Infant Modified Barium Swallow Studies: A Qualitative Investigation. Perspectives of the ASHA Special Interest Groups, 9(2), 440-447. https://doi.org/10.1044/2024_PERSP-23-00263

Practice Management, EHR/EMR and Teletherapy Platform

Exclusive therapy apps and games

Start 30 Day FREE TRIAL
92610 CPT code, CPT code 92610

4/11/2023

92610 CPT code

92610 CPT code is a good code for speech language pathologists who specialize in Dysphagia to know. Learn how to bill 92610 CPT code to ensure reimbursement.

92610 CPT code, CPT code 92610

4/11/2023

92610 CPT code

92610 CPT code is a good code for speech language pathologists who specialize in Dysphagia to know. Learn how to bill 92610 CPT code to ensure reimbursement.

Therapy Games Teletherapy Therapy Notes Telepractice Marketing For Therapists Starting a Private Practice Resources For Therapists Behavioral Health Therapy Billing Case Studies Telehealth Physical Therapy CPT Codes ICD 10 Codes Speech Therapy ICD 10 Codes Physical Therapy ICD 10 Codes Mental Health Mental Health Assessments CPT Codes Mental Health Practice Management Types Of Therapy Occupational Therapy Speech Therapy Physical Therapy Cognitive Behavioral Therapy Therapy Intake Forms Therapy Treatment Plans Therapy Goals ICD 10 Codes Occupational Therapy

Subscribe to our newsletter