This notice
provides recommended guidance on billing for translation as part of a child’s
core evaluation.
Currently, EI Providers
that complete a child evaluation with a translator often receive separate
authorizations for the core evaluation and the bilingual evaluation. Providers sometimes
interpret the two authorizations as an affirmation to bill the same evaluation code
twice on the same day. When a core evaluation is billed twice with the same CPT
code on the same date of service, commercial payers often opt to pay the lesser
billed amount of two claims.
In an effort to
increase EI payments, and to ensure that the commercial payers remit payment
for the core evaluation and reduce the duplicate claim denials, PCG recommends
that EI Providers add translation code T1013 to the core evaluation claim when
a translator is present during a child evaluation. Included below for reference
are some common core evaluation codes and the translation code.
Core
Evaluation Codes:
92523 – 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).
96112 – Developmental test administration by
physician or other qualified healthcare professional, with interpretation and
report; first hour) was added to replace 96111. Add CPT 96113 to indicate each
additional 30 minutes spent performing the activities described in 96112.
(Note: 96113 cannot be billed on a separate claim, the code must be billed on
the same claim which contains 96112)
Translation
Code:
T1013 – Sign language or oral interpretive
services, per 15 minutes.
If you have any
questions, please contact the PCG Customer Service Center at (866) 315-3747.
Article ID: 442, Created On: 6/29/2020, Modified: 6/29/2020