L31533 HOME HEALTH SPEECH-LANGUAGE PATHOLOGY

 

Region IV J11HH-11-004-L

 

01/01/2013

 

 

• Speech-language pathology services are part of a constellation of rehabilitative services designed to improve or restore cognitive functioning, communication skills and/or swallowing skills following congenital or acquired disease or injury.

• Speech-language pathologists use the clinical history, cognitive/language examination and a variety of evaluations to characterize individuals with impairments, functional limitations and disabilities. Impairments, functional limitations and disabilities thus identified are then addressed by the design and implementation of therapeutic intervention tailored to the specific needs of the individual patient.

• The specific interventions most commonly utilized are tasks/exercises to improve, maintain, train or retrain cognitive/memory skills, swallowing skills and overall communication skills; either verbal or non-verbal so the individual can communicate and function as effectively as possible with daily activities.

 

• Speech/hearing evaluation (CPT 92506)

o The identification, assessment diagnoses, and evaluation for disorders of:

 Speech, articulation, fluency, and voice (including respiration, phonation, and resonance)

 Language skills (involving the parameters of phonology, morphology, syntax, semantics, and pragmatics, and including disorders of receptive and expressive communication in oral, written, graphic, and manual modalities)

 Cognitive aspects of communication (including communication disability and other functional disabilities associated with cognitive impairment).

o *Note: The condition for which the speech-language pathologist is seeing patient must be expected to improve.

 

• Speech/hearing treatment (CPT 92507)

o The treatment/intervention, (e.g., prevention, restoration, amelioration, and compensation) and follow-up services for disorders of speech, articulation, fluency and voice, language skills and the cognitive aspects of communication:

 Providing consultation, counseling, and making referrals when appropriate

 Providing training and support to family members/caregivers and other communication partners of individuals with speech, voice, language, communication, fluency, hearing and swallowing disabilities

 Developing and establishing effective augmentative and alternative communication techniques and strategies, including selecting, prescribing and dispensing of aids and devices as identified by State Practice Acts and training individuals, their family members/caregivers, and other communication partners in their use.

• Regarding speech generating devices, use CPT 92607 for selection and prescription; use CPT 92609 for adaptation and training

 Selecting, fitting, and establishing effective use of appropriate prosthetic/adaptive devices for speaking

 Providing aural rehabilitation and related counseling services to individuals with hearing loss and to their family members/caregivers

 Providing interventions for individuals with central auditory processing disorders.

 

• Speech/Aural rehabilitation following cochlear ear implant (CPT codes 92626, 92627, 92630 and 92633)

o Aural rehabilitation following cochlear implant includes evaluation or aural rehabilitation status and hearing, and therapeutic services with or without speech processor programming. This may include:

 Extensive auditory rehabilitation therapy for patients with cochlear implants focusing on audition, cognition, language and speech skills.

 Family member or caregiver training for auditory verbal techniques.

 Improve patients’ auditory skills pertaining to the suprasegmental aspects

 Improve patients’ ability to discriminate and exhibit improvements in patient’s speech (manner, place and voicing).

o *Note: Speech processor programming is usually performed by an audiologist.

 

• Clinical evaluation of swallowing function (CPT 92610)

o The evaluation of oropharyngeal swallowing dysfunction including the phases of oral preparatory, oral/voluntary and pharyngeal in reference to oral and motility problems in the oral cavity and pharynx.

o The bedside clinical examination may include:

 History of patient’s disorder and awareness of swallowing disorder, and indications of localization and nature of disorder

 Medical status including nutritional and respiratory status

 Oral anatomy/physiology (labial control, lingual control, palatal function)

 Pharyngeal function

 Laryngeal function

 Ability to follow directions; (alertness)

 Interventions used to facilitate normal swallow; (compensatory strategies such as chin tuck, dietary changes, etc.)

 Identifying symptoms during attempts to swallow.

o The clinical examination can be divided into two phases:

 The pre-swallowing assessment/preparatory examination with no swallow

 The initial swallow examination with actual swallow while physiology is observed

• *Note: Based on the findings of a clinical evaluation, an instrumental examination may or may not be recommended.

o Despite positive clinical findings there are times when an instrumental examination may not be indicated

o (e.g., the patient is too medically unstable to tolerate a procedure, the patient is unable to cooperate or participate in and instrumental examination, in the speech-language pathologist’s judgment, the instrumental examination would not change the clinical management of the patient).

o In addition, because of the documented limitations of the clinical evaluation of swallowing, there may be scenarios where despite a “negative” clinical examination and instrumental examination may still be indicated. In these cases, information supporting the medical necessity of the instrumental examination should be documented in the medical record.

 

• Oral function therapy (CPT 92526)

o This involves the treatment for impairments/functional limitations of mastication, the preparatory, oral, and pharyngeal phases of swallowing.

 The speech-language pathologist may make appropriate recommendations (re: diet and compensatory techniques and instruct in direct/indirect therapies) to facilitate oral motor control for feeding.

 

• Evaluation of patient for prescription of speech generating devices (CPT 92607 & 92608)

o This includes evaluation of language comprehension and production across modalities: written, spoken and gestural.

 May also include evaluation of motor skills and nonverbal communication strategies (i.e., words, pictures, and vocalization). Includes evaluation of the ability to operate and effectively use a speech-generating device or aid.

 

• Patient adaptation and training for use of speech generating devices (CPT 92609)

o Includes development of operational competence in using a speech generating device or aids to include customizing the features of the device to meet the specific communication needs of each patient and providing opportunities for developing skills in all aspects of device use.

 

• Re-evaluation of patient using speech generation devices: (CPT 92607/92609)

o Re-evaluation of patient using speech generating devices or aids to supplement oral speech, assess need for continued use or identify need for changes in objectives.

 

• Evaluation of patient for prescription of voice prosthetic (CPT 92506)

o Patient is seen for a recommendation of a voice prosthetic. Patient’s ability to perform mechanics necessary to provide voice, care and cleaning of the unit are evaluated, as well as patient’s preference for the unit.

o (e.g., of voice prosthetics are tracheoesophageal valves, electrolarynges, speaking valves, and voice amplifiers).

 

• Modification or training in use of voice prosthetic (CPT 92507)

o Modifications in voice prosthetic to supplement oral speech would be appropriate and should be carried out by a speech-language pathologist. (Modification of voice prosthetic would involve programming or reprogramming device to meet the patient’s needs.)

Patient is seen postoperatively for training of the voice prosthetic.

 

• Assessment of aphasia (CPT 96105)

o Evaluation, assessment, diagnosis, and identification of a communication disorder characterized by complete or partial impairment of language comprehension, formulation and use; excluding disorders associated with primary sensory, general mental deterioration or psychiatric disorders by standardized or informal measures.

 

• Developmental testing; limited (CPT 96110)

o This includes screening/observations of cognitive abilities, gross and fine motor abilities and communication abilities necessary for performing daily activities, with interpretation and report.

 

• Developmental testing; extended (CPT 96111)

o This includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments; with interpretation and report.

 

• Neurobehavioral status exam (CPT 96116)

o Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g. acquired knowledge, attention, memory, visual spatial abilities, language functions, planning) with interpretation and report

 

• Standardized cognitive performance testing (CPT 96125)

o Evaluate abilities of executive (cognitive) function including: assessment of learning abilities, memory and working memory, abstract thought, language, and attention.

 

• Therapeutic exercises (CPT 97110)

o Describes exercises used to strengthen muscles (e.g., jaw, tongue, facial)

 

• Therapeutic activities (CPT 97530)

o Use of dynamic activities to improve functional performance

 

• Cognitive skills development (CPT 97532)

o Develop or restore cognitive status alertness, orientation, attention, memory, problem solving, recall, affect, reasoning, judgment, organization, and retention and informal assessment/observation of cognitive abilities necessary for performing daily activities.

 

• Sensory Integrative Techniques (CPT 97533)

o This modality may be used for patient’s needing oral sensory stimulation.

o The use of sensory integrative techniques is considered reasonable and necessary when patients must develop adaptive skills for sensory processing.

 When there has been a disruption of the auditory, vestibular, proprioceptive, tactile and/or visual system; interventions are required to assist the patient in remaining functional in their environment.

 The loss of sensory systems often compromises the safety of the patient; therefore therapy should provide adaptations that allow the patient to interact with their environment that promotes well-being.

 

• Self-care/home management training (CPT 97535)

o Compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment.

 

 

• Coding Information

 

Bill Type Codes:

• Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service.

• Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type.

• Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

 

032x Home Health - Inpatient (plan of treatment under Part B only)

033x Home Health - Outpatient (plan of treatment under Part A, including DME under Part A)

 

 

Revenue Codes:

• Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service.

• In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination.

• Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

 

0440  Speech Therapy - Language Pathology - General Classification

0441  Speech Therapy - Language Pathology - Visit

0444  Speech Therapy - Language Pathology - Evaluation or Reevaluation

 

CPT/HCPCS Codes

• Note: CPT/HCPCS code G0153 must be used by Home Health agencies billing a 32x or 33x bill types. The G0153 code is used to report the 15-minute increments, all other CPT/HCPCS codes listed in this policy are for informational and descriptive use only.

 

92506 Speech/hearing evaluation

92507 Speech/hearing therapy

92526 Oral function therapy

92607 Ex for speech device rx 1hr

92608 Ex for speech device rx addl

92609 Use of speech device service

92610 Evaluate swallowing function

92626 Eval aud rehab status

92627 Eval aud status rehab add-on

92630 Aud rehab pre-ling hear loss

92633 Aud rehab postling hear loss

96105 Assessment of aphasia

96110 Developmental screen

96111 Developmental test extend

96116 Neurobehavioral status exam

96125 Cognitive test by hc pro

97110 Therapeutic exercises

97530 Therapeutic activities

97532 Cognitive skills development

97533 Sensory integration

97535 Self-care mngment training

 

 

ICD-9 Codes that Support Medical Necessity

 

294.11 DEMENTIA IN CONDITIONS CLASSIFIED ELSEWHERE WITH BEHAVIORAL DISTURBANCE

294.21 DEMENTIA, UNSPECIFIED, WITH BEHAVIORAL DISTURBANCE

307.0 ADULT ONSET FLUENCY DISORDER

307.23 TOURETTE’S DISORDER

307.50 EATING DISORDER UNSPECIFIED

307.59 OTHER DISORDERS OF EATING

307.9 OTHER AND UNSPECIFIED SPECIAL SYMPTOMS OR SYNDROMES NOT ELSEWHERE CLASSIFIED

310.1 PERSONALITY CHANGE DUE TO CONDITIONS CLASSIFIED ELSEWHERE

315.00 - 315.09 DEVELOPMENTAL READING DISORDER UNSPECIFIED - OTHER SPECIFIC DEVELOPMENTAL READING DISORDER

315.31 - 315.32 EXPRESSIVE LANGUAGE DISORDER - MIXED RECEPTIVE-EXPRESSIVE LANGUAGE DISORDER

315.34 SPEECH AND LANGUAGE DEVELOPMENTAL DELAY DUE TO HEARING LOSS

315.35 CHILDHOOD ONSET FLUENCY DISORDER

315.4 - 315.8 DEVELOPMENTAL COORDINATION DISORDER - OTHER SPECIFIED DELAYS IN DEVELOPMENT

331.0 ALZHEIMER'S DISEASE

331.6 CORTICOBASAL DEGENERATION

341.0 - 341.1 NEUROMYELITIS OPTICA - SCHILDER'S DISEASE

341.8 - 341.9 OTHER DEMYELINATING DISEASES OF CENTRAL NERVOUS SYSTEM - DEMYELINATING DISEASE OF CENTRAL NERVOUS SYSTEM UNSPECIFIED

358.30 LAMBERT-EATON SYNDROME, UNSPECIFIED

358.31 LAMBERT-EATON SYNDROME IN NEOPLASTIC DISEASE

358.39 LAMBERT-EATON SYNDROME IN OTHER DISEASES CLASSIFIED ELSEWHERE

359.21 MYOTONIC MUSCULAR DYSTROPHY

359.22 MYOTONIA CONGENITAL

359.23 MYOTONIC CHONDRODYSTROPHY

359.24 DRUG INDUCED MYOTONIA

359.29 OTHER SPECIFIED MYOTONIC DISORDER

359.3 PERIODIC PARALYSIS

359.4 TOXIC MYOPATHY

388.40 ABNORMAL AUDITORY PERCEPTION UNSPECIFIED

388.41 DIPLACUSIS

388.43 IMPAIRMENT OF AUDITORY DISCRIMINATION

388.45 ACQUIRED AUDITORY PROCESSING DISORDER

389.00 - 389.04 CONDUCTIVE HEARING LOSS UNSPECIFIED - CONDUCTIVE HEARING LOSS INNER EAR

389.05 - 389.06 CONDUCTIVE HEARING LOSS, UNILATERAL - CONDUCTIVE HEARING LOSS, BILATERAL

389.08 CONDUCTIVE HEARING LOSS OF COMBINED TYPES

389.10 - 389.12 SENSORINEURAL HEARING LOSS UNSPECIFIED - NEURAL HEARING LOSS, BILATERAL

389.13 NEURAL HEARING LOSS, UNILATERAL

389.14 - 389.16 CENTRAL HEARING LOSS - SENSORINEURAL HEARING LOSS, ASYMMETRICAL

389.17 SENSORY HEARING LOSS, UNILATERAL

389.18 SENSORINEURAL HEARING LOSS, BILATERAL

389.20 MIXED HEARING LOSS, UNSPECIFIED

389.21 MIXED HEARING LOSS, UNILATERAL

389.22 MIXED HEARING LOSS, BILATERAL

389.7 DEAF, NONSPEAKING, NOT ELSEWHERE CLASSIFIABLE

438.10 SPEECH AND LANGUAGE DEFICIT UNSPECIFIED

438.11 APHASIA

438.12 DYSPHASIA

438.13 LATE EFFECTS OF CEREBROVASCULAR DISEASE, DYSARTHRIA

438.14 LATE EFFECTS OF CEREBROVASCULAR DISEASE, FLUENCY DISORDER

438.19 OTHER SPEECH AND LANGUAGE DEFICITS

438.81 APRAXIA CEREBROVASCULAR DISEASE

438.82 DYSPHAGIA CEREBROVASCULAR DISEASE

438.83 FACIAL WEAKNESS

478.30 - 478.34 UNSPECIFIED PARALYSIS OF VOCAL CORDS - COMPLETE BILATERAL PARALYSIS OF VOCAL CORDS

478.5 OTHER DISEASES OF VOCAL CORDS

524.20 - 524.29 UNSPECIFIED ANOMALY OF DENTAL ARCH RELATIONSHIP - OTHER ANOMALIES OF DENTAL ARCH RELATIONSHIP

524.50 DENTOFACIAL FUNCTIONAL ABNORMALITY, UNSPECIFIED

529.8 OTHER SPECIFIED CONDITIONS OF THE TONGUE

750.0 TONGUE TIE

750.10 - 750.19 CONGENITAL ANOMALY OF TONGUE UNSPECIFIED - OTHER CONGENITAL ANOMALIES OF TONGUE

780.99 OTHER GENERAL SYMPTOMS

781.8 NEUROLOGIC NEGLECT SYNDROME

783.3 FEEDING DIFFICULTIES AND MISMANAGEMENT

783.42 DELAYED MILESTONES

784.3 APHASIA

784.40 VOICE AND RESONANCE DISORDER, UNSPECIFIED

784.41 APHONIA

784.42 DYSPHONIA

784.43 HYPERNASALITY

784.44 HYPONASALITY

784.49 OTHER VOICE AND RESONANCE DISORDERS

784.51 DYSARTHRIA

784.52 FLUENCY DISORDER IN CONDITIONS CLASSIFIED ELSEWHERE

784.59 OTHER SPEECH DISTURBANCE

784.60 - 784.69 SYMBOLIC DYSFUNCTION UNSPECIFIED - OTHER SYMBOLIC DYSFUNCTION

784.99 OTHER SYMPTOMS INVOLVING HEAD AND NECK

786.1 STRIDOR

786.2 COUGH

787.20 DYSPHAGIA, UNSPECIFIED

787.21 DYSPHAGIA, ORAL PHASE

787.22 DYSPHAGIA, OROPHARYNGEAL PHASE

787.23 DYSPHAGIA, PHARYNGEAL PHASE

787.24 DYSPHAGIA, PHARYNGOESOPHAGEAL PHASE

787.29 OTHER DYSPHAGIA

799.52 COGNITIVE COMMUNICATION DEFICIT

 

V40.1 MENTAL AND BEHAVIORAL PROBLEMS WITH COMMUNICATION (INCLUDING SPEECH)

V41.2 PROBLEMS WITH HEARING

V41.4 PROBLEMS WITH VOICE PRODUCTION

V41.6 PROBLEMS WITH SWALLOWING AND MASTICATION

V43.81 LARYNX REPLACEMENT STATUS

V48.2 - V48.7 MECHANICAL AND MOTOR PROBLEMS WITH HEAD - DISFIGUREMENTS OF NECK AND TRUNK

V52.8 FITTING AND ADJUSTMENT OF OTHER SPECIFIED PROSTHETIC DEVICE

V55.0 ATTENTION TO TRACHEOSTOMY

 

General Information

 

Documentations Requirements

• Documentation supporting the medical necessity should be legible, maintained in the patient's medical record, and must be made available to the A/B MAC upon request.

• The plan of treatment written by the patient’s physician after any needed consultation with the qualified speech-language pathologist and signed by the physician.

o This must be in the patient’s medical record and made available to the A/B MAC upon request.

• When documenting family member/caregiver or communication partner training and education, the documentation should include the person being trained and the effectiveness of the training and education. The training and education should be an adjunct to active therapy with the patient.

• OASIS data should support the medical necessity of the services documented in the medical records.

o For therapy services the OASIS MO2200 should be filled out completely and filed with the State Repository.

o An updated and completed OASIS for the billing period should be on file with the State Repository and in the patient’s medical records to be made available to the A/B MAC upon request.

 

• Evaluation/Reevaluations

o The physician and/or the speech-language pathology’s evaluation/re-evaluation assess the area for which speech-language therapy is being planned. It must be completed prior to beginning therapy. Evaluations must contain the following information:

 Reason for referral

 Diagnosis/condition being treated

 Past level of function (be specific)

 Evaluations must contain physical and cognitive baseline data necessary for assessing rehabilitation potential and measuring progress.

 Current level of function

 Treatment modalities selected for treating current illness or injury

 Limitations which may influence the length of treatment

 Short and long term goals stated in objective measurable terms, and their expected date of accomplishment

 Frequency and duration of therapy

 Re-assessments must be performed at least every 30 days by a qualified speech-language pathologist. The 30 day clock begins with the first therapy’s visit/assessment/measurement/documentation (of the speech-language pathologist).

 

• Plan of Treatment

o Services are to be furnished according to a written plan of treatment determined by the physician after any needed consultations with the qualified speech-language pathologist and signed by the physician after an appropriate assessment (evaluation) of the condition (illness or injury) is completed.

o In the absence of a verbal order, the written plan of treatment must be completed before active therapy begins.

o The plan of treatment, it must be signed by the referring or attending physician prior to billing the service to Medicare.

o The written plan of treatment established by a physician may not be altered by a speech-language pathologist.

o *Electronic signatures are acceptable if the proper documentation is submitted to the A/B MAC.

o However stamped dates are not allowed.

o The written plan of treatment must contain the following elements:

 Diagnosis being treated and the specific problems identified that are to be addressed

 Specific treatments/interventions being used for each specific problem to attain the stated goals

 Specific functional goals for the treatments/interventions in measurable terms

 Amount, frequency, and duration of each treatment/intervention

 Rehabilitation potential - therapists/physician’s expectation of the patient’s ability to meet the goals at initiation of treatment

 

• Treatment Notes/Progress Notes

o A treatment note should be written for each visit. It should contain the objective measurable status of the patient, a description of the services performed, and the patient’s response, in objective measurable terms, to the services. Weekly progress notes should describe progress toward the treatment goals.

o The treatment note should document any treatment variations with the associated rationale.

o The treatment notes should be written using objective measurements and functional accomplishments. Use statements which demonstrate the patient’s response to the therapy such as:

 “Able to answer questions with 75% accuracy”

 “Name common items with 80% accuracy”

 “Able to sustain phonation 10 seconds during vowel production”

 “Oral intake trials without signs and symptoms of aspiration”

o Avoid terms that are not quantified, such as:

 “Doing well”

 “Improving”

 “Less pain”

 “Tolerated treatment well”

 

• Certification/Recertification

o The certifying physician must document that he or she or an allowed non-physician practitioner (NPP) had a face-to-face encounter with the patient.

 The encounter must occur no more than 90 days prior to the home health start of care date or within 30 days after the start of care.

o Content of the Physician’s Certification—No payment may be made for the Home Health speech-language pathology services unless the physician certifies that:

 A plan for furnishing such services is or was established by the physician after any needed consultation with the qualified speech-language pathologist and reviewed by the physician every certification/re-certification period.

 The services are or were furnished while the patient was under a written plan of care by a physician.

 The services are or were required by the patient.

o Certifications and re-certifications by the physician, must be on file and available to the A/B MAC upon request.

o Certifications are required upon initiation of therapy and with every certification/re-certification period thereafter for Home Health speech-language pathology services.

o The referring/attending physician establishes or reviews the plan of treatment and makes the necessary certifications.

 The referring/attending physician must sign all certifications/re-certifications.

 Signature means an actual handwritten signature or electronic signature.

o Documentation should indicate the prognosis for potential restoration of function in a reasonable and generally predictable period of time, or the need to establish a safe and effective maintenance program.

 

• Discharge Planning

o Should be addressed at the initiation of therapy

o Documentation must support that the speech-language pathologist discussed discharge planning with the patient/caregiver prior to the final visit.

 

Sources of Information and Basis for Decision

 

Nicolosi, L., Harryman, E., and Kersheck, J, (1978). Terminology of Communication Disorders. Maryland: The Williams & Williams Company.

A50420 - Coding Guidelines for Home Health Speech-Language Pathology opens in new window

 

Local Coverage Determination (LCD) for Home Health Speech-Language Pathology (L31533)