It has come to
our attention that some EI Billing Providers are receiving commercial insurance
denials due to incorrect unit designations in their coding for certain
speech-language therapy services. Below is
information on how to correct the issue.
The Current
Procedural Terminology (CPT®) system, developed by the American Medical
Association, is designed to ensure that health care data is captured accurately
and consistently and to facilitate proper processing of claims for health
services. In accordance with coding guidance from the American Speech-Language-Hearing
Association (ASHA), CPT codes 92507
(Treatment of speech, language, voice, communication, and/or auditory
processing disorder; individual) and 92526
(Treatment of swallowing dysfunction and/or oral function for feeding) have no
time designation. Each therapy session is billed as one procedure (1 unit)
regardless of length of session. Multiple units should not be reported when
using CPT code 92507 or CPT code 92526. More information regarding CPT coding for
Speech-Language Pathology services can be found at https://www.asha.org/practice/reimbursement/coding/TimedCodesFAQs/.
Billing
providers manually entering claims in NYEIS with either of these CPT codes
should check the number of units prior to finalizing claim submission. If
multiple units are reported with CPT code 92507 or 92526, modify the units to
“1” prior to finalizing claim submission in NYEIS. Electronic billers should verify the 837
includes the appropriate unit count when utilizing these procedure codes.
Below are
examples of correct and incorrect methods for reporting these procedure codes
on claims in NYEIS:
Correct number of units:
Incorrect number of units:
For claims
already submitted and finalized in NYEIS with the incorrect number of units
that are still pending adjudication from commercial insurance or Medicaid, please
contact PCG to manually adjust the claim(s) to reflect the correct units.
If
you have any questions regarding claiming functionality in NYEIS, please
contact the NYEIS Help Desk (518) 640-8390 or toll free at 1-833-395-7058.
Article ID: 408, Created On: 5/1/2019, Modified: 5/7/2019