New Speech Therapy Codes

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Effective with dates of services on or after January 1, 2014, the South Carolina Department of Health and Human Services (SCDHHS), in accordance with the Current Procedural Terminology (CPT), will discontinue coverage of the deleted code for Speech Evaluation (92506) and activate the new procedure codes listed below.  The following codes will be added to the list of reimbursable codes replacing the deleted procedure code 92506:

  • 92521  Evaluation of speech fluency (eg, stuttering, cluttering)
  • 92522  Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria);
  • 92523  Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language)
  • 92524  Behavioral and qualitative analysis of voice and resonance
  • 92610  Evaluation of oral and pharyngeal swallowing function

The replacement codes for procedure codes 92506 listed above may be billed once per lifetime on or after January 1, 2014 for the initial speech evaluation.  The codes listed above may not be billed if an initial evaluation has already been reimbursed using procedure code 92506. Procedure code S9152 should be utilized for speech re-evaluations.

Reimbursement is available for a subsequent initial evaluation when it is conducted as the result of a distinct speech disorder that was not previously detected.  Providers should maintain documentation of medical necessity in each patient’s medical file for review by the SCDHHS Program Integrity Division.

For more information regarding this bulletin, please contact the Provider Service Center (PSC) at (888) 289-0709. Thank You for your continued support of the South Carolina Healthy Connections Medicaid Program.

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