CPT code 92607
CPT code 92607 is a good code for speech pathologists who work with patients needing Augmentative and Alternative Communication (AAC) to know.
Here’s the official description of the CPT code 92607: Evaluation for prescription for speech-generating augmentative and alternative communication device, first hour, face-to-face.
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What is a CPT code and why are they important for speech therapists to know and use appropriately?
CPT (Current Procedural Terminology) codes are part of a uniform coding system managed by the American Medical Association (AMA).
Using CPT codes is a way to help ensure that the way services are documented by various medical professionals has consistency. All CPT codes are made up of five specific digits, and refer to a certain diagnosis.
Therapists are required to attach the corresponding CPT code for a procedure to their documentation when billing a therapy service for a client who has Medicare and Medicaid.
Private insurance companies also often require the use of CPT codes on treatment notes or evaluation reported for billing purposes.
Familiarity with commonly used CPT codes in their scope of practice help an SLP’s documentation and billing remain efficient.
To view a list of current CPT codes, therapists can visit the Centers for Medicare & Medicaid Services (CMS) website.
Here are the must-know details on an important code for SLPs who work with AAC: CPT code 92607.
What is code 92607?
The 92607 CPT code description is: Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour.
It should be used by speech therapists when billing an AAC evaluation.
The evaluation should be focused on assessing a client’s proficiency with using an Augmentative and Alternative Communication (AAC) device to communicate. The time may include:
- Assessment of the client’s ability to use an AAC Device (also known as a Speech Generating Device or SGD) to communicate.
- Information about the client’s method of accessing the device (i.e., touch, switch, eye gaze).
- Ruling out other methods of communication, such as speech, sign language, and low tech picture communication boards.
- A request for the client’s physician to write a prescription for a specified AAC device and recommended accessories (such as a keyguard or wheelchair mount).
Speech language pathologists can bill the 92607 CPT code. This code is time-based, and may only be billed once per day.
According to ASHA, SLPs who are seeking to identify the most appropriate code for billing services should use the “best” code to describe the services they provide.
Here are some examples of procedures in which the provider can attach the 92607 CPT code to documentation and billing:
- AAC Evaluation for a nonverbal child with Cerebral Palsy
- Evaluation for a Speech Generating Device for an adult client with expressive language difficulties due to a stroke that resulted in Aphasia.
- Both of these would include a request for the physician to sign a prescription for a specific model of AAC device with a specified communication software loaded on it.
Is 92607 a timed code?
CPT codes are categorized as either being timed or service-based procedures.
The 92607 CPT code is timed. It should be used for the specific procedure that matches its description, for the first hour face-to-face with the client.
The CPT code 92608 should be used for each additional 30 minutes used for the AAC evaluation.
Follow these steps to correctly bill for the 92607 CPT code
- Refer to the AMA CPT manual. Be sure that the 92607 CPT code is the best, most appropriate code for you to use for the service you provided.
- Complete documentation for the evaluation (i.e., an AAC evaluation report with a prescription/recommendation for a speech generating device).
- Attach the 92607 CPT code. Attach the Healthcare Common Procedure Coding System (HCPCS) Level II code to describe the SGD equipment recommended (device and accessories).
- Another option is for the SLP to complete a superbill. This superbill can be submitted directly to the payor (ex: Medicaid, Medicare, or private insurance) or to the client.
- Automated billing can also be used. This easy and efficient way of billing with the 92607 CPT code is offered by TheraPlatform.
The SLP’s documentation for the evaluation should reflect that the client has a treatment diagnosis related to the description of the 92607 CPT code.
Several ICD-10 codes may be associated with the need for an AAC evaluation and AAC device recommendations.
These include the following ICD 10 codes:
- F80.2 Mixed Receptive-Expressive Language Disorder
- R48.8 Other Symbolic Dysfunctions
- R48.2 Apraxia of Speech
- F80.4 Speech and language Development Delay due to Hearing loss
- R47.01 Aphasia
- Other treatment diagnoses associated with expressive language difficulties that may contribute to the client’s need for an Augmentative Alternative Communication device.
The assessment procedures targeted within the session should also relate to the areas outlined in the description for CPT code 92607.
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Do’s and don’ts of CPT code 92607
Here are some key points to remember, and errors to avoid, when billing the 92607 CPT code. This can help reduce the likeliness of a reimbursement denial:
- Use the code for evaluation, not treatment.
- Do not bill using the 92607 CPT code more than one time in a day.
- Use the 92607 CPT code for selecting and prescribing an AAC device. The 92609 CPT code should be used for future sessions training the client and family to use the AAC device.
- Document the length of time that the AAC evaluation took. Use the 92607 CPT code for the first 60 minutes of face-to-face time, and the 92608 CPT code for each additional 30 minutes of the evaluation if applicable (this can be billed in multiple units).
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Reimbursement for CPT code 92607
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 2023 national fee for the 92607 CPT code is $121.99.
Reimbursement rates of private insurance payers vary according to specific plans. Determining whether the client’s insurance plan covers Speech Therapy (including an evaluation with the 92607 CPT code) for their specific diagnosis is important. Verify this, and encourage your client to do so as well, prior to initiating services to maximize reimbursement for this code.
This fee may or may not be similar to a private provider who does not accept insurance. Sometimes those providers choose to set their prices for services to be similar to Medicare or Medicaid reimbursement rates.
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Coding changes
Clinicians should stay current on updates to CPT codes, which are performed periodically. Changes may affect the way the clinician bills for services.
SLPs can remain up to date with changes to the 92607 CPT code 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.
Speech Language Pathologists who work with clients needing Augmentative and Alternative Communication (AAC) should be familiar with the 92607 CPT code. 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 significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to creating, 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 a series of 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 speech therapy 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 all together by enabling auto credit card charge.
- Automated claim creation and submission: Batch multiple claims with one click of a button or turn auto claim creation and submission on.
- Live claim validation: The system goes over each claim to catch any human errors before submitting, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA all the payments from them will be automatically posted 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 the storage and sharing of billing and insurance an easy decision and can save providers 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
