Article Rating

  • 0 Rating(s)
  • 0
  • 0
  • 0
  • 0
  • 0

CPT/HCPCS Codes Accepted in the EI-Hub

During provider claims (837P file) loader testing, Public Consulting Group (PCG) received valuable feedback from testers regarding claim rejections attributed to certain CPT/HCPCS codes. 

The Bureau of Early Intervention (Bureau) used the transition to the EI-Hub as an opportunity to review claims data. The Bureau dedicated over a year to reviewing CPT/HCPCS codes in an effort to better align the codes with the professions and services provided in the Early Intervention Program. As a result of this intensive review, many CPT/HCPCS codes were removed and subsequently made unavailable for use in the EI-Hub. It’s important to note that though the reimbursement rates for available CPT/HCPCS codes remain consistent, the codes are updated yearly by the American Medical Association (AMA); therefore, the listing below is subject to change. 

Below is a list of the CPT/HCPCS codes accessible in the EI-Hub. We recommend referring to this list when preparing 837P files to mitigate rejections due to CPT/HCPCS code. We also recommend sharing this information with your claims vendor to facilitate any necessary modifications to their system. 

CPT/HCPCS code 

Description 

90791 

Psychiatric diagnostic evaluation 

90792 

Psychiatric diagnostic evaluation with medical services 

90832 

Psychotherapy, 30 minutes with client or family member 
Do not bill with 90847 for the same DOS 

90834 

Psychotherapy, 45 minutes with client or family member 
Do not bill with 90847 for the same DOS 

90837 

Psychotherapy, 60 minutes with client or family member 
Do not bill with 90847 for the same DOS 

90838 

Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure). See 90837, as this should be used with 99202-92255, 99304-99316, and 99341-99350. If billing 60M psychotherapy only, then bill 90837 

90846 

Family psychotherapy (without the patient present), 50 minutes 

90847 

Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes 
Do not report 90832-90838 with 90847 for the same DOS 

90849 

Multiple-family group psychotherapy 

90853 

Group psychotherapy (other than of a multiple-family group) 
Do not report with 97151-97158 for the same DOS 

92507 

treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 
Do not report with 97153 and 97155 for the same DOS 

92508 

treatment of speech, language, voice, communication, and/or auditory processing disorder; group, two (2) or more individuals 
Do not report with 97154 and 97158 for the same DOS 

92520 

Laryngeal function studies (i.e., aerodynamic testing and acoustic testing) This is bilateral code; if only one (1) side is tested, use modifier 52  

92521 

Evaluation of speech fluency (e.g., stuttering, cluttering) 
Special otorhinolaryngologic services are those diagnostic and treatment services not included in an evaluation and management service, including office or other outpatient services (99202-99215)  

92522 

Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) 
Special otorhinolaryngologic services are those diagnostic and treatment services not included in an evaluation and management service, including office or other outpatient services (99202-99215)  

92523 

Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria); with an evaluation of language comprehension and expression (e.g., receptive and expressive language) 
Special otorhinolaryngologic services are those diagnostic and treatment services not included in an evaluation and management service, including office or other outpatient services (99202-99215)  

92524 

Behavioral and qualitative analysis of voice and resonance 
Special otorhinolaryngologic services are those diagnostic and treatment services not included in an evaluation and management service, including office or other outpatient services (99202-99215)  

92526 

treatment of swallowing dysfunction and/or oral function for feeding 
Special otorhinolaryngologic services are those diagnostic and treatment services not included in an evaluation and management service, including office or other outpatient services (99202-99215)  

92550 

Tympanometry and reflex threshold measurements 
Do not use it in conjunction with 92567. All services include testing of both ears; if only 1 ear, use modifier 52 

92551 

Screening test, pure tone, air only 
This is bilateral code; if only 1 ear is tested, use modifier 52 

92552 

Pure tone audiometry (threshold); air only 
This is bilateral code; if only 1 ear is tested, use modifier 52 

92553 

Pure tone audiometry (threshold); air and bone 
This is bilateral code; if only 1 ear is tested, use modifier 52 

92555 

Speech audiometry threshold 
This is bilateral code; if only 1 ear is tested, use modifier 52 

92556 

Speech audiometry threshold with speech recognition 
This is a bilateral code; if only 1 ear is tested, use modifier 52 

92557 

Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined) 

92567 

Tympanometry (impedance testing) 
This is a bilateral code; if only 1 ear is tested, use modifier 52 

92568 

Acoustic reflex testing, threshold 
For eval of speech, language, and/or hearing problems through observation and assessment of performance, see 92521, 92522, 92523, 92524. If the test is performed on only 1 ear, it has to be billed with modifier 52.   

92570 

Acoustic immittance testing includes tympanometry (impedance testing), acoustic reflex threshold testing, and acoustic reflex decay testing. 
Do not report w 92568. also; if it is one ear, not two, they must use modifier 52 

92571 

Filtered speech test 
This is a bilateral code; if only 1 ear is tested, use modifier 52 

92579 

Visual reinforcement audiometry (VRA) 
This is a bilateral code; if only 1 ear is tested, use modifier 52 

92582 

Conditioning play audiometry 
This is a bilateral code; if only 1 ear is tested, use modifier 52 

92583 

Select picture audiometry 
This is a bilateral code; if only 1 ear is tested, use modifier 52 

92587 

Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report; this is a bilateral code; if only 1 ear is tested, use modifier 52 

92588 

Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation (quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12 frequencies), with interpretation and report; this is a bilateral code; if only 1 ear is tested, use modifier 52 

92590 

Hearing aid examination and selection; monaural 

92591 

Hearing aid examination and selection; binaural; this is a bilateral code; if only 1 ear is tested, use modifier 52 

92592 

Hearing aid check; monaural 

92593 

Hearing aid check; binaural; this is a bilateral code; if only 1 ear is tested, use modifier 52 

92595 

Electroacoustic evaluation for a hearing aid; binaural; this is a bilateral code; if only 1 ear is tested, use modifier 52 

92596 

Ear protector attenuation measurements: this is a bilateral code; if only 1 ear is tested, use modifier 52 

92610 

Evaluation of oral and pharyngeal swallowing function 

92630 

Auditory rehabilitation; pre-lingual hearing loss 

92633 

Auditory rehabilitation; post-lingual hearing loss 

92650 

Auditory evoked potentials; screening of auditory potential with broadband stimuli, automated analysis (effective 1/1/21); this is a bilateral code; if only 1 ear is tested, use modifier 52 

92651 

Auditory evoked potentials for hearing status determination, broadband stimuli, with interpretation and report (effective 1/1/21) 
Do not bill with 92652 and 92653; this is a bilateral code; if only 1 ear is tested, use modifier 52 

92652 

Auditory evoked potentials for threshold estimation at multiple frequencies, with interpretation and report (effective 1/1/21) 
Do not bill with 92651 and 92653; this is a bilateral code; if only 1 ear is tested, use modifier 52 

92653 

Auditory evoked potentials; neurodiagnostic, with interpretation and report (effective 1/1/21) 
Do not bill with 92651 and 92652; this is a bilateral code; if only 1 ear is tested, use modifier 52 

96105 

Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, e.g., by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour 
For the development of cognitive skills, see 97533 

96110 

Developmental testing; limited (e.g., Developmental Screening Test II, Early Language Milestone Screen), with interpretation and report 
To report developmental testing, see 96112 and 96113 

96112 

Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed), by physician or other qualified health care professional, with interpretation and report; first hour 
For the development of cognitive skills, see 97533 

96113 

Developmental test administration (including assessment of fine and/or gross motor, language, cognitive level, social, memory and/or executive functions by standardized developmental instruments when performed) by a physician or other qualified health care professional, with interpretation and report; each additional 30 minutes (List separately in addition to code for primary procedure) 
For the development of cognitive skills, see 97533 

96116 

Neurobehavioral status exam (clinical assessment of thinking, reasoning, and judgment, [e.g., acquired knowledge, attention, language, memory, planning and problem-solving, and visual-spatial abilities]) by a physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; first hour 

96121 

Neurobehavioral status exam (clinical assessment of thinking, reasoning, and judgment, [e.g., acquired knowledge, attention, language, memory, planning and problem-solving, and visual-spatial abilities]), by a physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; each additional hour (List separately in addition to code for primary procedure) 

96130 

Psychological testing evaluation services by a physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour 
For the development of cognitive skills, see 97533 

96131 

Psychological testing evaluation services by a physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; each additional hour (List separately in addition to code for primary procedure)   
For development of cognitive skills see 97533 

96156 

Health behavior assessment, or re-assessment (i.e., Health-focused clinical interview, behavioral observations, clinical decision making) 

96158 

Health behavior intervention, individual, face-to-face; initial 30 minutes 

96159 

ADD ON Health behavior intervention, individual, face-to-face; each additional 15 minutes (List separately in addition to code for primary service)  

96164 

Health behavior intervention, group (2 or more 
patients), face-to-face; initial 30 minutes 

96165 

ADD ON Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (List separately in addition to code for primary service) 

97110 

The therapeutic procedure 1 or more areas every 15 minutes; therapeutic exercises to develop strength and endurance, range of motion, and flexibility 
For group therapeutic procedure, see 97150 

97112 

Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 
For group therapeutic procedure, see 97150 

97116 

Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing) 

97124 

Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) 
For myofascial release, see 97140 

97140 

Manual therapy techniques (e.g., mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes 

97150 

Therapeutic procedure(s), group (2 or more individuals)  
CPT 97150 should be reported for each member of the group (2 or more individuals) 

97151 

Behavior identification assessment, administered by a physician or other qualified health care professional, every 15 minutes of the physician’s or other qualified health care professional’s time face-to-face with patient and/or guardian(s)/caregiver(s) administering assessments and discussing findings and recommendations, and non-face-to-face analyzing past data, scoring/interpreting the assessment, and preparing the report/treatment plan  

97152 

Behavior identification supporting assessment, administered by one technician under the direction of a physician or other qualified health care professional, face-to-face with the patient, each 15 minutes 
CPT 97151 and 97152 may be repeated on the same or different days until the behavior identification assessment [97151] and, if necessary, supporting assessment [97152] is complete. For psychiatric diagnostic evaluation, see 90791 and 90792.   

97153 

Adaptive behavior treatment by protocol, administered by a technician under the direction of a physician or other qualified health care professional, face-to-face with one patient; each 15 minutes 
Adaptive behavior treatment codes 97154, 97155, and 97158 describe services that address specific treatment targets and goals based on results of previous assessments [see 97151, 97152] and include ongoing assessment and adjustment of treatment protocols, targets, and goals.   

97154 

Group adaptive behavior treatment by protocol, administered by a technician under the direction of a physician or other qualified health care professional, face-to-face with two or more patients, each 15 minutes 
Do not report 97154 for a group with >8 patients. Do not report 97154 with 90785-90899, 92508, 96105-96171, or 97150.   

97155 

Adaptive behavior treatment with protocol modification administered by a physician or other qualified health care professional, which may include simultaneous direction of technician, face-to-face with one patient, each 15 minutes 
Do not report with 90785-90899, 92507, 96105-96171, or 97150.   

97158 

Group adaptive behavior treatment with protocol modification, administered by a physician or other qualified health care professional face-to-face with multiple patients, each 15 minutes 
Do not report for a group with more than 8 patients. Do not report with 90785-90899, 96105-96171, 92508, or 97150.   

97161 

Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family. 

97162 

Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family. 

97163 

Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family. 

97165 

Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance deficits (i.e., relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. The patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is not necessary to enable completion of the evaluation component. Typically, 30 minutes are spent face-to-face with the patient and/or family. 

97166 

Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 3-5 performance deficits (i.e., relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. The patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is necessary to enable the patient to complete the evaluation component. Typically, 45 minutes are spent face-to-face with the patient and/or family. 

97167 

Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 5 or more performance deficits (i.e., relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. The patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (e.g., physical or verbal) with assessment(s) is necessary to enable the patient to complete the evaluation component. Typically, 60 minutes are spent face-to-face with the patient and/or family. 

97530 

Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes 

97533 

Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes 

97535 

Self-care/home management training (e.g., activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in the use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 15-minute 

97542 

Wheelchair management (e.g., assessment, fitting, training), each 15-minute 

97755 

Assistive technology assessment (e.g., to restore, augment, or compensate for existing function, optimize functional tasks, and/or maximize environmental accessibility), direct one-on-one contact, with a written report, every 15 minutes.  

97760 

Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes 
Should not be reported with 97116 for same extremity(ies). Codes 97010-97763 should be used to report each distinct procedure performed. Do not append modifier 51 to 97010-97763.   

97761 

Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes 

97763 

Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes 
Do not report 97763 with 97760, 97761 

97802 

Medical nutrition therapy: initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes 

97803 

Medical nutrition therapy: re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes 

99202 

An office or other outpatient visit is required for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision-making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter. 

99203 

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and a a low level of medical decision-making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter. 

99204 

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter. 

99205 

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and a high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter. 
CPT 99417 is for service 75 minutes or longer; this is not currently an EI code, did you want to have it considered?   

99212 

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter. 

99213 

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and a low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter. 

99214 

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision-making. When using time for code selection,30-39 minutes of total time is spent on the date of the encounter. 

99215 

Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and a high level of medical decision-making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter. 

99510 

Home visit for individual, family, or marriage counseling 

A0090 

Non-emergency transportation, per mile - vehicle provided by an individual (family member, self, neighbor) with a vested interest 

A0110 

Non-emergency transportation and bus, intra or inter state carrier 

E1399 

Durable medical equipment, miscellaneous 

H2019 

Therapeutic behavioral services per 15 minutes 

H2027 

Psychoeducational service, per 15 minutes 

L7510 

Repair of a prosthetic device, repair or replace minor parts. 

S5150 

Unskilled respite care, not hospice, per 15 minutes 

S9446 

Patient education, not otherwise classified, non-physician provider, group, per session 

T1001 

Nursing assessment/evaluation 

T1002 

Rn services, up to 15 minutes 

T1003 

Lpn/lvn services, up to 15 minutes 

T1013 

Sign language or oral interpretive services, per 15 minutes 

T1017 

Targeted case management, each 15 min (TL Modifier) 

T1023 

Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project, or treatment protocol per encounter 

T1027 

Family training and counseling for child development, per 15 minutes (effective 1/1/2013) 

T2003 

Non-emergency transportation (each one-way trip) 

V2799 

Vision item or service, miscellaneous 

V5010 

Assessment for hearing aid 

V5011 

Fitting/orientation/checking of hearing aid 

V5014 

Repair/modification of a hearing aid 

V5020 

Conformity evaluation 

V5264 

Earmold/insert, not disposable, any type 

V5267 

Hearing aid or assistive listening device/supplies/accessories not otherwise specified. 

V5275 

Ear impression, each 


If you have additional questions, please get in touch with the PCG Billing and Claiming Team at nysfaeip@pcgus.com or 844-880-8713.

Article ID: 493, Created On: 4/29/2024, Modified: 5/14/2024

Feedback (0)