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[DYSPHAGIA] SLP Charges
Be careful with the time allocation and coding these days. While HCFA has
its interpretation of the rules and they are often tied to the AMA CPT code
interpretation, each fiscal intermediary (Wellmark, Aetna, etc.) might have
their own interpretation.
The new fee schedules for therapies paid in outpatient settings (long term
care, hospitals, etc.) are tied to a number of factors. Those factors include
business overhead, staff time, etc. For the code 92507, the clinical time is
something like .5-.6 hours. That is why managers are limiting treatment
time. They are only being paid for that much patient care time. Some payors
are still covering the service at 15 minute increments, however they are
gradually going to a single rate for the "visit." The new 2001 rates should
improve enough so that the single visit rate might allow for a little more
than thirty minutes of treatment. Keep in mind that some payors also allow a
speech pathologist to add-on to the 92507 speech-language therapy code and
provide services such as 97110 (range of motion strengthening and exercise),
97530 (functional activity). These can be done in 15 minute increments.
Some/many fiscal intermediaries are not allowing these additional codes and
therefore you are limited to the 30 minute treatment (or at least only 30
minutes of payment). It is very important that you know how you fiscal
intermediary views the use of these codes by SLP's. Our fiscal intermediary
does not allow us to use 92507 (speech therapy) with 97770 (cognitive rehab)
on the same day. Go figure. We have to do provide speech/language treatment
on one day and cognitive treatment on the next. But the point is, we have to
know their rules and play by them or get in trouble. I do believe that we
need to try to work with the system to get this stuff changed. It won't
happen overnight. ASHA has been of great help in working with us and our
fiscal intermediary to improve the interpretation of these codes for
speech/language/dysphagia treatments.
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