CPT code 92523
CPT code 92523 is a code many speech and language pathologists need to understand as part of the evaluation process. Especially as close to 5% of children have a noticeable speech disorder by the time they enter first grade.
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When working with a new client who hasn’t received therapy before, speech therapists often start with a comprehensive evaluation. That’s why it’s important for them to be familiar with the CPT code 92523.
The CPT code 92523 is defined as: the evaluation of speech sound production with evaluation of language comprehension and expression.
What are CPT codes and why is it important to be familiar with them?
CPT refers to Current Procedural Terminology. CPT codes are part of a uniform coding system that is managed by the American Medical Association (AMA).
CPT codes are used in documentation and billing so that there can be consistency of services among different medical professionals across the U.S.
Therapists are required to attach the corresponding CPT code for the procedure to their documentation when billing a therapy service (such as treatment or an evaluation) to Medicare and Medicaid.
If your client has private insurance, the use of CPT codes is also often required for billing therapy services.
Why is it important to be familiar with commonly used CPT codes in your practice?
It can make documentation and billing more accurate and efficient.
While SLPs can go to the Centers for Medicare & Medicaid Services (CMS) website to view a list of current CPT codes, it can be helpful to have more details on what certain codes refer to and when to use them.
This guide includes all of the need-to-know information about the important CPT code 92523 used by SLPs.
What is the CPT code 92523?
Here’s the complete description of the CPT code 92523 from ASHA:
Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (e.g., receptive and expressive language).
This code should be used by speech therapists when billing a Communication Evaluation (also known as a Speech Therapy Evaluation or a Speech and Language Evaluation/Assessment).
The evaluation should be focused on assessing both a client’s speech production skills and his or her expressive and receptive language skills.
Therefore, the assessment will likely include the following:
- Oral-Peripheral Evaluation: An assessment of the structure and function of the oral/facial musculature.
- A conversational speech sample with analysis of language and articulation.
- A speech intelligibility rating, reported as a percentage.
- Thorough review of the client’s history, including medical history, academic performance, and client/caregiver concerns.
- Standardized assessment of expressive language and auditory comprehension skills through clinical observation and/or standardized testing such as:
- The Preschool Language Scale - 5th Edition (PLS-5), the Clinical Evaluation of Language Fundamentals (CELF), Boston Diagnostic Aphasia Examination, or others.
- Formal or informal assessment of speech production through clinical observation and/or standardized testing such as:
- The Goldman Fristoe Test of Articulation (GFTA), an Apraxia assessment such as the Kaufman Speech Praxis Test, or others.
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Speech-Language Pathologists can bill the CPT code 92523. This code is not time-based, meaning it can be used no matter how long the evaluation, including necessary testing, takes. This code can only be billed once per day for an individual client.
ASHA encourages SLPs to strive to use the “best” code to describe the services they provide. Pinpointing what that code is, for billing services, isn’t always clear.
Here are some examples of procedures in which the provider can attach the CPT code 92523 to documentation and billing:
- An assessment of a 3 year old with suspected Apraxia of Speech, who is struggling with speech production and has a reduced vocabulary.
- A speech therapy evaluation with a 7 year old who has a lisp, trouble using appropriate grammar, and difficulty processing age-appropriate concepts.
- An adult client who has had a stroke and now has dysarthric speech in addition to expressive and receptive language difficulties.
How to use the CPT code 92523
The CPT code 92523 is intended to be used for a specific procedure that matches its description.
To correctly bill for theCPT code 92523, follow these steps:
- Refer to the AMA CPT manual. Ensure when reading CPT code descriptions that CPT code 92523 is the most accurate and appropriate code for you to use for the service you provided.
- Complete documentation for the evaluation (i.e., an evaluation report).
- Attach the CPT code 92523.
- SLPs have the option to complete a superbill. This superbill can be submitted directly to the payor (ex: Medicaid, Medicare, or private insurance) or to the client.
- Use automated billing, which is an easy and efficient way of billing theCPT code 92523. Automated billing is available through TheraPlatform.
In the Evaluation report, Speech-Language Pathologists should document that the client has a treatment diagnosis related to the description of theCPT code 92523.
For example, one or several of the following ICD-10 codes may apply to the client:
- R48.2 Childhood Apraxia of Speech
- F80.0 Specific Speech Articulation Disorder
- R47.1 Dysarthria
- R47.01 Aphasia
The assessment procedures targeted within the evaluation should also relate to the areas outlined in this code’s description.
Here are some key points to remember when billing the CPT code 92523, as well as some errors to avoid. Keep these in mind to help reduce the likeliness of a reimbursement denial:
- Use this code for evaluation, not a treatment session.
- Do not bill using the CPT code 92523 more than one time in a day.
- For evaluation of stuttering/fluency, use CPT 92521 (not 92523).
- If you only address speech sound production, and not expressive/receptive language skills, then use CPT 92522 (not 92523). These 2 codes cannot be billed in conjunction with one another.
- Distinguish this code from CPT 92524; Behavioral and quantitative analysis of voice and resonance.
What is the reimbursement rate for 92523?
ASHA’s Medicare Fee Schedule for Speech-Language Pathologists is a helpful source that can guide SLPs on which CPT code to use and current reimbursement rates.
The national fee for 2023 for the CPT code 92523 is $224.48.
Reimbursement rates of private insurance payers vary according to specific plans. Determining whether the client’s insurance plan covers Speech Therapy (including sessions in which the CPT code 92523 code billed) for their specific diagnosis is important. You should verify this and encourage your client to do the same, prior to initiating services to maximize reimbursement for this code.
This fee may be similar to a private provider who does not accept insurance. Those providers sometimes choose to set their prices for services to be similar to Medicare or Medicaid reimbursement rates.
Coding changes
Clinicians should stay current on updates to CPT codes, which are performed periodically. This is important because changes may affect the way the clinician bills for services.
Recent changes affecting CPT Code 92523
In January 2014, the 92506 CPT code (Evaluation of speech, language, voice, communication, and/or auditory processing) was deleted. Four new, more specific codes replaced it, including CPT code 92523.
It’s important to stay up to date with changes like these to CPT codes you commonly use.
Failure to comply with current requirements or not using the most appropriate CPT code can result in insurance denials or delayed reimbursement for services.
SLPs can remain up to date with changes to the CPT code 92523 by checking the AMA’s CPT codebook when updates are made. CPT codes are updated by the AMA annually and are effective for use on January 1st of each year.
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The CPT code 92523 is important for Speech Language Pathologists who provide speech and language evaluations to children and adults. By staying current on what types of treatment the code includes and when to use it, providers can have more assurance that they’re following AMA guidelines and will receive reimbursement for services.
How EHR and practice management software can save speech therapists time with insurance billing
EHR with integrated billing software and a clearing house, such as TheraPlatform offers speech therapists 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 click of 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.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any 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 SLPs time when it comes to 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
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
- Insurance billing 101
- Practice management tools
